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).