Placenta accreta is a substantially life threatening condition and one of the causes of maternal morbidity and mortality in the world. According to study done in United Kingdom, The estimated incidence of placenta accreta/increta/percreta was 1.7 per 10,000 maternities overall and 577 per 10,000 in women with both a previous cesarean delivery and placenta previa. in a tertiary south Italian center, The incidence increased from 0.12% during the 1970s, to 0.31% during the 2000s.While in United States of America, the prevalence of placenta accreta was 3.7 per 1000 deliveries.

Inclusion Criteria:

1. Low implantation of the gestational sac (<4 cm from external os) by transvaginal ultrasound
2. Presence of placental lakes by transvaginal ultrasound
3. Disruption of placental-myometrial interface by transvaginal ultrasound
4. Trophoblast overlapping a uterine scar (Cesarean section, myomectomy) by transvaginal ultrasound
5. Intraplacental dilated vessels by Doppler ultrasound
6. Turbulent blood flows by Doppler ultrasound
7. Greatly increased periplacental vascularity by Doppler ultrasound

Exclusion Criteria:

a) Cases far away from our hospital and expected to be lost to be followed. b) Pregnant women who will refuse to Participate

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first trimester pregnancy between 11 weeks and 13 weeks.