Background: An optimal international standard for PAS surgery is not yet available, and the establishment of a suitable surgical method is an important focus of in PAS management.

Objective: To assess the efficacy and safety of tourniquet uses for conservative approach in the management of placenta accerta spectrum.

Patients and Methods: 40 pregnant women who underwent conservative management of placenta accrete at Kasr El-Aini hospital (Obstetrics and gynecology department - Faculty of medicine - Cairo university) were included and were divided according to the use of tourniquet into 2 equal groups: Study group (tourniquet group): consists of 20 women for whom tourniquet was used in the lower part of the uterus during surgical treatment of placenta accreta spectrum.Control group (no tourniquet group): consists of 20 women for whom no tourniquet was used.

Inclusion Criteria:

• Pregnant females with previous CS deliveries (at least 1).
• Patients with ultrasound criteria of placenta accerta spectrum.
• Patients desiring fertility (uterine conservation).
• Patients with gestational age that completed 34 weeks (or more) confirmed by the 1st day of the LMP or 1st trimester ultrasound scan.

Exclusion Criteria:

• Maternal age above 40 years.
• Chronic medical disorders (e.g., cardiac, renal, DM and hepatic diseases).
• Patients presented with severe antepartum hemorrhage (unstable vital signs).
• Patients requested radical management (caesarean hysterectomy).