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Published:October 14, 2014DOI:https://doi.org/10.1016/j.ajog.2014.10.018
      We thank Drs Levine and Fernandez for their interest in our recent article regarding accuracy of ultrasound for the diagnosis of placenta accreta. We agree that ultrasound is reasonably useful for the diagnosis of accreta and that it may be improved with newer technology. However, our purpose was to illustrate that the modality is imperfect and that there might be room for improvement. Additionally, we discussed that the pretest probability for accreta is strongly driven by clinical history, and that posttest probabilities after ultrasound examination may not significantly alter clinical decision making in certain high-risk patients (eg, those with placenta previa and >2 prior cesarean deliveries).

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      • Diagnosing placenta accreta
        American Journal of Obstetrics & GynecologyVol. 212Issue 2
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          While we wish to underscore a statement made in the editorial by Dr Nageotte,1 we wish to also add a relevant comment to the article by Bowman et al2 discussed in this same issue. In our own institution, we have seen a significant rise in the incidence of placenta accreta (doubling in the past dozen years), emphasizing the obvious contribution of the recently rising rate of cesarean. The concern that this should raise for the average practicing obstetrician is considerable, with regard to the results of this commonly unanticipated occurrence.
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