Snapshot A 28-year-old G3P2 female at 39 weeks of gestation is on the labor and delivery floor in active labor. The cervix is 10 centimeters dilated and preparations are made for delivery of the newborn. A male neonate is born with appropriate Apgar scores and without any perinatal complications. During placental delivery there is a lot of resistance when traction is placed on the umbilical cord. After an attempt at manual placental separation, there is profuse bleeding. Obstetric history is significant for previous cesarean delivery. She has missed a number of prenatal visits during this pregnancy. Introduction Overview login to view 2 more bullets Epidemiology Incidence login to view 3 more bullets Risk factors login to view 6 more bullets ETIOLOGY Pathogenesis login to view 3 more bullets Classification Placenta accreta spectrum login to view 6 more bullets Presentation Symptoms login to view 2 more bullets Physical Exam login to view 1 more bullet Imaging Transvaginal or transabdominal ultrasonography login to view 14 more bullets Studies Histology login to view 2 more bullets Maternal serum alpha-fetoprotein login to view 1 more bullet Differential Placenta increta Placenta percreta login to view 4 more bullets Complications Massive hemorrhage Death Prognosis 27% morbidity login to view 1 more bullet Risk of death from sequelae of massive hemorrhage