In the present study, it was investigated whether gestational trophoblast localization at the cesarean scar was associated with increased monocyte chemoattractant protein-1 (MCP-1) and cholesterol synthesis in women's blood and decidual stromal cells. Patients who underwent abortion at 6-10 weeks of gestation were divided into three groups: cesarean scar pregnancy (CSP), normal intrauterine pregnancy without history of cesarean section (NP), and normal intrauterine pregnancy after cesarean section (NPACS). Blood and decidual tissue at the localization of the gestational sacs were collected from the patients, and RNA sequencing, PCR and ELISA were used to detect differences in the expression of thrombin receptor protease-activated receptor-1 (PAR-1), MCP-1, CCR2, chemokine (C-C motif) receptor 2 (CCR2) and cholesterol synthesis-related proteins sterol regulatory element-binding protein 2 (SREBP2), 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR) and hydroxy-methyl-glutaryl Coenzyme A synthase (HMGCS). The expression of PAR-1, MCP-1, CCR2, SREBP2, HMGCR and HMGCS in the blood and the decidual stromal cells at the localization of the gestational sac was significantly higher in women with CSP than in the other two groups of patients, whereas the expression of these molecules between NP group and NPACS were not significantly different, and the total blood cholesterol levels of women with cesarean scar pregnancies were significantly higher than those of the other two groups. The development of CSP was associated with a high cholesterol environment and increased MCP-1 expression in women.