• Classifying the profound morbidity risk in patients presenting with placenta previa and prior cesarean sections.
• Directing surgical planning (e.g., scheduled cesarean hysterectomy, massive transfusion protocols).
• Pre-operative counseling regarding the extreme risk of catastrophic pelvic hemorrhage.

• Multiple irregular placental lacunae ("Swiss cheese" appearance)
• Loss of the normal retroplacental clear space
• Myometrial thickness < 1 mm
• Bridging vessels spanning from placenta into bladder wall (Percreta)

• DO NOT attempt manual removal of the placenta if PAS is aggressively suspected or confirmed intraoperatively. Forcing a cleavage plane will trigger instant, massive, and virtually uncontrollable pelvic hemorrhage.
• If diagnosed unexpectedly upon opening the abdomen during a routine C-section, do not disturb the placenta. Close the hysterotomy, pack the abdomen if needed, and call immediately for Gynecologic Oncology or a highly experienced surgical rescue team.

• Schedule controlled delivery at 34 0/7 to 35 6/7 weeks.
• Assemble multidisciplinary team: MFM, Gyn Oncology, Urologist (for ureteral stents), Trauma/Transfusion Medicine.
• Perform classical (vertical) hysterotomy vastly superior to the placental edge to deliver the infant without cutting through the placenta.
• Leave placenta strictly *in situ* undisturbed.
• Proceed directly to total hysterectomy with the placenta still inside the uterus.

Placenta Accreta was exceptionally rare before the 1980s. The colossal rise in global cesarean section delivery rates created a man-made pathological phenomenon where fertilized eggs preferentially implant over scarred, defective anterior lower uterine segment tissue.