Current trends of advanced maternal age, increased uptake of assisted reproductive technologies (ART), and rising caesarean section rates have resulted in higher incidences of heterotopic pregnancy, specifically caesarean section pregnancy (CSP). Despite the rarity of the diagnosis, when encountered in clinical practice, it presents a diagnostic and management dilemma. We report a rare case of a spontaneous dichorionic–diamniotic (DCDA) pregnancy, with a heterotopic CSP, and one intrauterine pregnancy at 7 weeks gestation. The CSP was treated with ultrasound guided potassium chloride (KCl) injection with the view of continuing with the intrauterine pregnancy. Despite achieving asystole in the CSP, follow–up ultrasound 10 days post procedure revealed an enlarging CSP trophoblastic ring with surrounding haematoma. The risk of uterine rupture was deemed too high at this stage to avoid further operative management, and a laparoscopic excision of the caesarean scar ectopic was undertaken, with surgical termination of the live intrauterine pregnancy using suction dilatation and curettage