Abnormal placental implantation (API) is an uncommon obstetrical phenomenon that is associated with significant maternal morbidity. Typically, the diagnosis of API is made at the time of delivery in the third trimester. However there are reports of API presenting in the second trimester, and rarely in the first trimester. Cesarean Scar Pregnancy (CSP) can be considered a subset of API. Early API rarely occurs in the absence of previous uterine manipulation. CSP is always associated with previous cesarean delivery. Nonetheless, it has been suggested that CSP and early API are histologically indistinguishable and both are precursors of API.