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EDITORIAL COMMENT: This contribirtion w~i s suhnzitterl ,for consider(ition .fi)r publicution as u letter to the editor: The uuthor is one of' Austruliu's most senior obstetricians. The editor Ims known him well ,for 45 years und c.otz.sirler.s him to he both un impressive scholcir uncIjofi,rmidrd.de iconoclast. I n ciu'dition he is writing on his ,favourite subject, concerning which he has anulyzecl the releiwit liternture ,for muny years, often in relation to providing opinions in C N S~S being consiclerecljbr litiption. He also has the distinction of usiiullv prmriu'ing opinions ,from the point of viecc. of patients ruther than dcfenu'unts (ohstetricinns, hospitals) in such cuses. We have not invited the authors whose pupers are nzentioned to respond to his comments. The editorial committee of the journal und oiir other reviewers ugreed that this muterial should he ofered to our readers us it stutids f i i r their considerution.

Summary Placenta accreta is a very rare condition, although minor degrees probably occur more frequently than can be recognized. The abnormal relationship between the chorionic tissue and the decidua may involve part or all of the placental surface. The depth of involvement also varies … the chorionic villi may abut directly on to the surface of the myometrium, or pass into its substance, or progress through it to the serous surface of the uterus. Six cases are described and are compared with 34 cases collected from the recent literature. Placenta accreta may be suspected if there is a history of manual removal or curettage after delivery, or if the existing pregnancy is complicated by placenta praevia. The complications of placenta accreta are considered, and it is emphasized that methods of management which are usually adequate may not suffice when this condition is present. Occasionally hysterectomy may be necessary, and if so the subtotal operation with preservation of the ovaries is the procedure of choice. It is important to conduct obstetrics in hospitals with readily available facilities for blood transfusion, and for surgical treatment if necessary, if maternal death due to this abnormality is to be prevented.

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