The worldwide incidence of abnormally invasive placenta is rapidly rising, following the trend of increasing cesarean delivery. It is a heterogeneous condition and has a high maternal morbidity and mortality rate, presenting specific intrapartum challenges. Its rarity makes developing individual expertise difficult for the majority of clinicians. The International Society for Abnormally Invasive Placenta aims to improve clinicians' understanding and skills in managing this difficult condition. By pooling knowledge, experience, and expertise gained within a variety of different healthcare systems, the Society seeks to improve the outcomes for women with abnormally invasive placenta globally. The recommendations presented herewith were reached using a modified Delphi technique and are based on the best available evidence. The evidence base for each is presented using a formal grading system. The topics chosen address the most pertinent questions regarding intrapartum management of abnormally invasive placenta with respect to clinically relevant outcomes, including the following: definition of a center of excellence; requirement for antenatal hospitalization; antenatal optimization of hemoglobin; gestational age for delivery; antenatal corticosteroid administration; use of preoperative cystoscopy, ureteric stents, and prophylactic pelvic arterial balloon catheters; maternal position for surgery; type of skin incision; position of the uterine incision; use of interoperative ultrasound; prophylactic administration of oxytocin; optimal method for intraoperative diagnosis; use of expectant management; adjuvant therapies for expectant management; use of local surgical resection; type of hysterectomy; use of delayed hysterectomy; intraoperative measures to treat life-threatening hemorrhage; and fertility after conservative management.

Centre Hospitalier Régional Universitaire de Nancy Université de Lorraine France

Department of Gynaecological Oncology Erasmus Medical Center Rotterdam Netherlands

Department of Gynecology Obstetrics 2 and Reproductive Medicine Hôpitaux Universitaires Paris Centre Hôpital Cochin APHP; Sorbonne Paris Cité Université Paris Descartes Faculté de Médecine Paris France

Department of Neuroscience Reproductive Sciences and Dentistry University of Naples Federico 2 Naples Italy

Department of Neuroscience Reproductive Sciences and Dentistry University of Naples Federico 2 Naples Italy; Department of Women Children and of General and Specialized Surgery University Luigi Vanvitelli Naples Italy

Department of Obstetrics and Gynecology CHR Citadelle University of Liege Liege Belgium

Department of Obstetrics and Gynecology Division of Obstetrics and Feto Maternal Medicine Medical University of Vienna Vienna Austria

Department of Obstetrics and Gynecology Erasmus Medical Center Rotterdam Rotterdam Netherlands

Department of Obstetrics and Gynecology Fetomaternal Medical Center Helsinki University Hospital and University of Helsinki Finland

Department of Obstetrics and Gynecology General Faculty Hospital Charles University Prague Czech Republic

Department of Obstetrics and Gynecology Hôpital Pellegrin CHU de Bordeaux Bordeaux France

Department of Obstetrics and Gynecology Hôpital Trousseau Assistance Publique des Hôpitaux de Paris Sorbonne University Paris France

Department of Obstetrics and Gynecology South General Hospital Stockholm Sweden

Department of Obstetrics Cliniques Universitaires Saint Luc Brussels Belgium

Department of Obstetrics Rigshospitalet University of Copenhagen Denmark

Department of Perinatology and Gynecology University of Medical Sciences Poznan Poland

Departments of Obstetrics and Division of Experimental Obstetrics Charité Universitätsmedizin Berlin corporate member of Freie Universität Berlin Humboldt Universität zu Berlin and Berlin Institute of Health Campus Virchow Klinikum and Campus Charité Mitte Berlin Germany

Division of Obstetrics and Gynaecology Norwegian National Advisory Unit on Women's Health Oslo University Hospital Rikshospitalet and Institute of Clinical Medicine University of Oslo Oslo Norway

Nuffield Department of Women's and Reproductive Health University of Oxford Oxford UK; The Fetal Medicine Unit John Radcliffe Hospital Oxford UK

Port Royal Maternity Unit Cochin Hospital Paris Descartes University DHU Risk and Pregnancy Assistance Publique Hôpitaux de Paris Paris France

Prenatal Zurich Zürich Switzerland; Heinrich Heine University Düsseldorf Germany

Vivantes Network for Health Clinicum Neukoelln Clinic for Obstetric Medicine Berlin Germany

Vrouw and Baby University Medical Centre Utrecht Utrecht University Utrecht Netherlands

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