A randomized prospective surgical case series study Setting: antenatal and labor wards and operative theater at AL-Zahra maternity and pediatric teaching hospital at Al-Najaf city, Iraq (tertiary referral center). Participants: patients admitted through the reception room or outpatient clinic, 198 multiparous women in the third trimester ≥30 wk., all patients had a history of prior cesarean section and all cases with a diagnosis of placenta accreta by Doppler ultrasound and at the surgery.