The diagnosis of placenta accreta spectrum (PAS) in pregnancy is associated with severe maternal complications and is potentially life threatening. Moreover, PAS is difficult to diagnose in the first trimester, and the accuracy is low. A prenatal diagnosis is pivotal for planning an optimal management in PAS. A first trimester US(Ultrasound) can detect PAS in good proportion of cases, although the sensitivity is lower than a second or third trimester US. An early first trimester US can further help predict severity of PAS and its surgical outcome. As the management and diagnosis remains a challenge as far as PAS in early pregnancy is concerned, a high clinical suspicion especially in cases of previous uterine scar and bleeding following a surgical evacuation cannot be overemphasised. We report a case of Placenta Percreta in First Trimester, its rarity and diagnostic dilemma.