The purpose of this document is to present evidence-based approach to the management of placental abnormalities and major obstetric hemorrhage. Attention to improving the hospital systems is necessary for the care of women at risk for major obstetric hemorrhage. It is important in the effort to decrease maternal mortality from hemorrhage. Multidisciplinary team implementation systemic changes are also discussed. It is the responsibility of the physician to decide without delay whether the cause is benign or potentially life-threatening to the mother, fetus, or both. The potential harm from either procrastination or unnecessary intervention may be extreme.