Additional file 2 of Combination of medical and surgical management in successful treatment of caesarean scar pregnancy: a case report series

Additional file 2 Fig. S1. Patient 1. Panel A. Gestational sac present at the level of uterine isthmus, localised within CS scar. Embryo not seen. Panel B. Increased peri-throphoblastic vascularization on color Doppler. Panel C. Gestational sac still present day 5 post-treatment with methotrexate. Panel D. Trophoblastic vascularization on color Doppler on day 5 post-treatment with methotrexate. Fig. S2. Patient 2. Panel A. Gestational sac of 15.4 mm, present at the level of uterine isthmus, localised at the level of CS scar. Yolk sac present. Embryo not seen. Panel B. Thick walls of gestational sac with increased peri-trophoblastic vascularization on color Doppler. Panel C. TVUS surveillance 5 days later. Persistent gestational sac at the isthmus, uterine cavity with blood content. Panel D. TVUS surveillance day 5. Persistent vascularization at the gestational sac-myometrium interface on color Doppler. Fig. S3. Patient 2. Panel A. Gestational sac persistent at re-admission, 10 days after the initial hospital discharge. Yolk sac present. Panel B. Present peri-trophoblastic vascularization on color Doppler. Embryo present. Panel C. Gestational sac retrieved by D&C. Panel D. Foley catheter was inserted at the level of uterine isthmus to tamponade the site of pregnancy implantation. Fig. S4. Patient 3. Panel A. Gestational sac localized at the level of CS scar. Panel B. Embryo present within gestational sac. Panel C. Embryo with cardiac activity present. Panel D. Day 8 after the therapy was initiated, the gestational sac and embryo were still present, showing peri-trophoblastic vascularization on color Doppler. Panel E. TVUS at 6 weeks showing an empty uterus and normal appearance of the CS scar at the isthmus. Fig. S5. Patient 4. Panel A. TVUS day 1 showing heterogeneous uterine content. A gestational sac was not seen at this time. Panel B. Gestational sac present. No embryo seen on day 3 of surveillance. Panel C. Day 10 of surveillance showing pregnancy in resolution. Panel D. TVUS 1 month after discharge showing resolution of scar pregnancy. Fig. S6. Patient 5. Panel A. TVUS day 1 showing a gestational sac with an embryo located at the level of previous CS scar. Panel B. Doppler color showing the peri-trophoblastic rich vascularization. Panel C. Day 7 of surveillance showing persistence of gestational sac. Panel D. Doppler color day 7 of surveillance showing persistence of scar pregnancy. Panel E and F. TVUS at 2 years from the CSP showing a normal anterior wall with normal appearance of the CS scar. Fig. S7. Patient 6. Panel A. TVUS on admission day showing a gestational sac with an embryo located at the level of previous CS scar. Panel B. TVUS post curettage showing a hyperechoic, heterogeneous mass (retained products of conception) located within the isthmus, at the level of previous CS scar. Doppler color showing persistence of vascularization within the mass. Panel C. TVUS post curettage showing an empty uterine cavity. Panel D. Two weeks follow up TVUS showing a persistent and growing mass at the isthmic level. Panel E. Doppler color showing persistence of intense vascularity around the remnant isthmic mass. Fig. S8. Patient 6. Panel A. Appearance of the uterus at the laparotomy. Note normal size of the uterus and bladder high on the isthmus, adherent post CS. Panel B. Appearance of the uterus, bulging isthmo-cervical region and both adnexa at laparotomy, after lysis of bladder adhesions. Panel C. Characteristics features of invasive placenta seen after further dissection.