Background: Many maternal and fetal complications werereported during delivery for patients diagnosed to have placenta accrete spectrum (PAS). Cesarean delivery (CD) isconsidered to be the most common risk factor for developing PAS disorders during pregnancy specially with increasing rate of CD in developing countries.Methods: A cross- sectional study over 12 months in a tertiary care obstetric unit between January 2020 and January2021.Results: 47 pregnant females having history of previousone CD were divided into 2 groups after ultrasonic and intraoperative evaluation of placenta site and invasion to theuterine wall.14 cases were in the low risk group ad 33 caseswere in the high-risk group. The mean ages of patients were(27.6 ± 4.6 & 27.6 ± 4.6, p value =0.961) respectively. Themedian gravidity was (3 & 2) in both groups. We found that36.4 % of case in the high-risk group had unreliable indications of the primary CD. Emergency caesarean deliverieswere done in about 18 % of cases in the high-risk group either due to failure to progress in labour or foetal distress.We reported successful conservative management in bothgroups using either cervico-isthmic compression sutureor step wise approach. There was statistically significantin the mean amount of intraoperative blood loss (1000 ml(850-1200) &1600 ml (850-2500), p < 0.001) in the low andhigh-risk groups respectively. We reported 3 cases of intraoperative pulmonary embolism, urinary bladder injury and HELLP (hemolysis, elevated liver enzymesand low platelet count) syndrome among patients in the high-risk group. There was statistically significant longer hospital stay durationamong patients in the high-risk group rangingfrom 2 days up to 21 days. On the other hand,there were no serious complications reportedin the low risk group.Conclusion: Decreasing rate of primary CDand optimizing obstetric care are mandatoryto prevent maternal of fetal complication thatcould happen due to having future PAS. Fertility sparing surgery is feasible during surgical management of PAS disorders.