The diagnosis and management of morbidly adherent placenta

The incidence of morbidly adherent placenta (MAP) has risen 13-fold since the early 1900s and is directly correlated with the rising rate of cesarean delivery. It is important for clinicians to screen all pregnancies for MAP at the time of routine second-trimester ultrasonography. In addition, patients with risk factors (e.g., multiple prior cesarean deliveries) should undergo targeted screening for MAP. Optimal maternal and fetal outcomes for these high-risk pregnancies result from accurate prenatal diagnosis and comprehensive multidisciplinary preparation and delivery between 34 and 36 weeks of gestation. There continue to be large knowledge gaps with respect to the optimal management of this condition especially around diagnosis, obstetric care, timing of delivery, and surgical management. Accordingly, most recommendations are based on expert opinion rather than on high-quality evidence. Prospective clinical trials are needed to address knowledge gaps and to continue to improve outcomes. (C) 2018 Elsevier Inc. All rights reserved.