Abstract: Objective To analyze the clinical efficacy of high intensity focused ultrasound ablation (HIFU) in the treatment of cesarean scar pregnancy (CSP) and explore its value in clinical practice. Methods Eighty-four CSP patients diagnosed and treated in our department from January 2014 to January 2017 were selected and randomly divided into two groups. Patients in observation group were treated with HIFU ablation, and the control group was treated with uterine artery embolization (UAE). The general data of cases in two groups were recorded and the clinical outcomes between two groups were compared. Results There was no significant difference between the two groups in age, gestational age, body mass index, number of caesarean section, gestational sac diameter, and clinical classification (P> 0.05). The length of hospitalization and the average treatment cost of observation group were less than those of control group (6.0±1.5) d vs (8.9±3.1) d, P< 0.05; (8 839.5±975.1) yuan vs (15 726.4±1 834.7) yuan, P< 0.05. The time of blood β-HCG returned to the normal in the observation group was longer than that of the control group (42.3±16.2) d vs (28.7±8.0) d, P< 0.05. No significant difference was found in the incidence of complications 9 cases (21.4%) vs 13 cases (30.9%) and the success rate of treatment 37 cases (88.1%) vs 41 cases (97.6%) between the two groups. Conclusion HIFU ablation is safe and effective for the treatment of CSP with less costs and shorter hospital stay.