Shamshirsaz AA, Carusi D, Shainker SA, et al. - Researchers aimed at comparing the characteristics and outcomes of placenta accreta spectrum (PAS) in twin and singleton pregnancies via conducting a retrospective cohort study of women with PAS from 2010–2018 at 5 academic institutions within the Pan American Society for Placenta Accreta Spectrum (PAS2). They performed inclusion of a total of 555 histology-confirmed PAS individuals in this study: 512 women (92.2%) with singleton gestations and 43 women (7.8%) with twin gestations. Per observations, antenatal detection of PAS was less frequent in twin compared with singleton gestations; this was correlated with a significantly increased total transfusion of RBC units. Missed antenatal detection seems to be due to (1) a lower index of suspicion, because of less frequent identification of traditional risk factors (previa and previous cesarean deliveries) in the twin PAS group and (2) technical limitations of imaging in the setting of twin pregnancy (reduced visibility of the entire placental mass on ultrasound scanning). They recommend clinicians to be aware of the potential to miss PAS antenatally in twins and to consider PAS when nontraditional risk factors are present.