The incidence of placenta accreta has increased 10-fold in the past 50 years and now occurs with a frequency of 1 per 2,500 deliveries. Women who have had two or more cesarean deliveries with anterior or central placenta previa have nearly a 40% risk of developing placenta accreta. If the diagnosis or strong suspicion of placenta accreta is formed before delivery, the patient should be counseled about the likelihood of hysterectomy and blood transfusion. Blood products and clotting factors should be available. Cell saver technology should be considered if available as well as the appropriate location and timing for delivery to allow access to adequate surgical personnel and equipment. A preoperative anesthesia assessment should be obtained.