Is there a role for magnetic resonance imaging in cesarean scar pregnancy after the first trimester?

Magnetic resonance imaging (MRI) can provide additional information in cases of cesarean scar pregnancy beyond the first trimester. MRI and 3D reconstructions can demonstrate the relationships between the uterus, cervix, bladder, and placenta, improving the spatial perspective of the pelvic anatomy in cases requiring surgical management. MRI and 3D reconstructions can also provide more comprehensive images for parental counseling, virtual and face-to-face multidisciplinary team discussion, and medical record storage. The authors declare no conflicts of interests. Data available on request from the authors. Figure S1: Two different moments of a CSP. In (A), at 6 weeks of gestation, the pregnancy crosses the serosal line (arrow, image from referral). In B and C, magnetic resonance imaging in coronal and sagittal T2-weighted sequences at 32 weeks' gestation. The placenta previa shows signs of high risk for placenta accreta spectrum disorder, namely the globular, thick and heterogeneous placenta with dark bands adhering to the anterior segment of the uterus, with marked myometrial thinning and loss of retroplacental space. (B) coronal view; (C) sagittal view; c, cervix. Video S1: Magnetic resonance imaging coronal and sagittal T2-weighted sequences of a CSP at 8 weeks gestation. Pregnancy distends the uterine segment and the uterine cavity is preserved and empty. Note the significant distortion of the uterine segment with lateral displacement of the uterine corpus. GS, gestational sac. Video S2: Magnetic resonance imaging sagittal T2-weighted sequences of a CSP at 14 weeks gestation, from Figure 1C. The pregnancy implanted in the uterine segment does not distend the uterine cavity and dislocates the uterus with its empty cavity cranially. The presence of dark bands, myometrial thinning, and loss of retroplacental space are present on the placenta. Note the marked increase in vascularization in the lateral part of the placenta (arrowhead) and in the uterine posterior vascularization (asterisk). Video S3: Three-dimensional reconstruction of the CSP in the 14th week of pregnancy on Video S2. The relationship between the placenta (magenta), the fetus, and the uterine cavity and cervix (both in green) is easy to see. The vascularization was segmented (in red) for spatial perception of the vessels and the CSP-uterus relationship. Note the irregular distribution of the vascularization. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.