We report the case of a 30-year-old woman in the first trimester with a cesarean scar pregnancy (CSP) following a previous caesarean section, who wished to preserve the pregnancy. External advice had previously recommended termination, but an individualized, experimental approach was agreed upon. At 11th weeks’ gestation, a mesh was placed over the scar dehiscence and secured in position. The uterus was strongly retroflexed, and the placenta prolapsed through the scar. Direct closure of the cranial and caudal myometrium surrounding the protruding placenta was not feasible; the defect measured approximately 4 cm, and the prolapsed placenta was the size of a mandarin. The patient was closely monitored until 32 weeks’ gestation, when she presented with lower abdominal pain and mild vaginal bleeding. A hysterectomy was performed at the patient’s request, although a focal resection had been offered. This case demonstrates that live birth can be achieved in extreme CSP and suggest that mesh coverage of large cesarean scar defects may represent a novel, pregnancy-preserving therapeutic option.