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Introduction: Placenta accreta spectrum is characterised histologically by a total or partial absence of decidua and placental adherence to or invasion of the myometrium. Risk factors include previous caesarean delivery, placenta previa with previous one or more cesarean delivery, advanced maternal age, multiparity, prior uterine surgeries/curettage Case: A 30 year old lady, G2P1001 at 28 weeks of gestation with previous LSCS with a resolving large subchorionic hematoma since early pregnancy with severe anemia came in preterm premature rupture of membranes in labour to the emergency. She was being treated for immune hemolytic anemia following a blood transfusion during her second trimester. She was diagnosed of placenta accreta on the day of preterm labour at 28 weeks of gestation with severe anemia with a hemoglobin of 7g%. No compatible blood products were available due to her alloimmune hemolytic anemia condition. Multidisciplinary teams involved and pre requisites fulfilled. She underwent a vaginal delivery, and delivered an alive female baby of 1kg. PPH was managed with all necessary measures and placenta was left in situ with adequate antibiotic cover. A decision of conservative approach over surgical management was made. Patient was followed up till 1 year, post delivery, to note the complete resolution of the placental mass in the uterus. Conclusion: Cesarean hysterectomy is the management of choice in most Placenta Accreta spectrum. Conservative or expectant management should be considered for carefully selected cases after detailed counselling and under close supervision in placenta accreta spectrum.