Placenta accreta, increta and percreta cause a significant risk for hemorrhage, maternal morbidity and mortality. Care coordination and advance planning, availability of blood products, and interdisciplinary resources are essential to mitigate this risk. Statement of the Problem Background The Society of Maternal Fetal Medicine states that “the reported incidence of accreta has increased from 0.8 per 1000 deliveries in the 1980s to 3 per 1000 deliveries in the past decade.” Placenta previa in the presence of prior cesarean section or uterine scare is a significant risk factor for development of placenta accreta. The FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel state that the increase in placenta accreta is a consequence of the rise of cesarean sections over the last two decades. SMFM & ACOG Guidelines for Placenta Accreta spectrum Placenta Accreta: Mitigating Risk with CNS Lead Multidisciplinary Team Coordination Jamie Vincent, APRN-CNS, RNC-OB, C-EFM, Perinatal Clinical Nurse Specialist Strategy and Implementation Evaluation Quality & Process Improvement References Perinatal Morbidity and Mortality reviews Quarterly auditing and quality & process improvement action plans Hung, T.H., Shau, W.Y., Hsieh, C.C., Chiu, T.H., Hsu, J.J., and Hsieh, T.T. Risk factors for placenta accreta. Obstet Gynecol. 1999; 93: 545–550 (Case-control level II-2) Jauniaux, E., Chantraine, F., Silver, R.M., Langhoff-Roos, J. (2018). FIGO consensus guidelines on placenta accreta spectrum disorders: Epidemiology. International Journal of Gynecology and Obstretrics.:140: 265-273. Silver, R. M. & Branch, D. W. (2018). Placenta Accreta Spectrum. New England Journal of Medicine. 378: 1529-1536. Society of Maternal Fetal Medicine (SMFM). (2010). SMFM Clinical Opinion Placenta Accreta. American Journal of Obstetrics and Gynecology. November 2010. pp. 430-439. Normal Placenta Placenta Accreta https://www.nejm.org/doi/suppl/10.1056/NEJMcp1709324/suppl_file/nejmcp1709324_appendix.pdf https://www.nejm.org/doi/full/10.1056/NEJMcp1709324#section_key_clinical_points https://www.nejm.org/doi/full/10.1056/NEJMcp1709324#section_key_clinical_points Uterus Post-hysterectomy: Placenta In situ: Classical Fundal incision is closed Placenta is bulging the lower uterine segment Increased vascularity is evident The placenta is almost visible through the lower uterine segment, and there is evidence of increased vascularity. The fetus has been delivered through a fundal uterine incision, which has been repaired.