**5. Recommendations and future directions**

The path to a reduced morbidity and mortality in women with AIP starts with an accurate antenatal diagnosis. However, we are not yet able to define specific US sign or set of signs when assessing the depth of placental malformation [31, 32]. Although many efforts were made to standardize the imaging description of PAD [33, 34], more prospective studies are needed to study the correlation between antenatal imaging findings and histopathology [35].

When suspecting a PAD prenatally, it is mandatory to refer the patient to a center of excellence with a dedicated multidisciplinary team and care plan [36]. Although the described techniques in the literature have shown satisfactory results in terms of safety and effectiveness, the reproducibility of the results might be improved by an analysis and an application of these techniques on larger case series in the future.

is very important in selecting the strategy and in involving a multidisciplinary team when dealing with these critical situations. Gynecologic oncology has added a lot of value to the surgical techniques applied in cesarean hysterectomy and adapted to percreta cases. Also, we should not also underestimate the important role of the radiologist in suspecting early the diagnosis, alerting the surgeon, and subsequently inducing a cascade of preoperative prepa-

Placental Malformation: Accreta and Beyond http://dx.doi.org/10.5772/intechopen.80588 81

**Figure 5.** Schematic steps to be followed in the management of an abnormal invasive placentation (AIP).

David Atallah\*, Malak Moubarak, Souha Saliba, Malek Nassar, Sara Abboud,

Saint Joseph University, Hôtel-Dieu de France University Hospital, Beirut, Lebanon

Assaad Kesrouani, Michel Ghossain and Nadine Elkassis \*Address all correspondence to: david.atallah@gmail.com

ration (**Figure 5**).

**Author details**

Obstetricians and gynecologists need to be counseled and advised about the indications and the situations where a conservative approach could be attempted. Case-control studies on large populations should be conducted to help the surgeon in making the decision when tending to a conservative management.
