I would like to commend Fox et al for an in-depth review on the conservative management of morbidly adherent placenta (MAP).

I cannot emphasis enough the authors’ notion that clear eligibility and endpoints must be established before conserving the uterus and the willingness to abandon such a measure with the proposed criteria that were suggested in the article. My experience with MAP certainly supports this statement, especially with a presentation of preterm labor and the need for immediate delivery. Antenatal diagnosis remains paramount to guide further management. In my series, 4 women with MAP presented with antepartum hemorrhage, while 3 women were diagnosed intraoperatively with MAP.

The current preferred management in Australia and the United States remains surgical, which is in line with the current committee opinion. As suggested by the authors, conservative methods should be considered; however, a contingency plan for emergency hysterectomy must be anticipated, preferably in a center of excellence. The saving grace would be that most women with MAP are older and multiparous, hence the need to conserve fertility would be low unless strongly desired by the women.

With the rising cesarean delivery rates, there is an inevitable rising epidemic of MAP. Therefore a standardized consensus is needed among all colleges and societies of obstetrics and gynecology to further guide clinicians in the management of MAP, especially in the setting of conserving the uterus.