Abstract Background: The incidence of morbidly adherent placen-tation has increased in the current era of obstetrics paralleling the cesarean rate. The problem of abnormal placental adherence is a significant contributor to maternal morbidity and requires multi-disciplinary care for management. Aim of Study: To assess uterine incision pattern and its effect on fetal and maternal outcome in morbidity adherent placenta. Subjects and Methods: This was a prospective cohort study, was carried out at damnhour, El-Hussein and Al-Sayed Galal Hospitals on 66 patients with placenta accreta starting from 1/6/2018 till 1/1/2020. Result: A total of 4400 cases were included with mean age 29.8 years and mean body mass index was 28.07, as regard parity p1-2 accounted for 40.8% of cases, p3-4 in 59.2%, mean gestational age was 36.7, Previous 1 cesarean section in 29.1%, 2 cesarean section in 3.3%, 3 cesarean section in 0.8 and no previous cesarean section in 66.8 of cases, Previous uterine surgery founded in 0.5% of cases, abnormal placenta suspected in 100 cases confirmed only in 66 cases. In com-parison between longitudinal or transverse incision in cases with abnormal placenta there was significant relation between Line of management, Dissection of bladder (100.0, 100.0), visceral injuries (83.9, 100.0), mortality (0.0, 10.0). Conclusion: Early antenatal diagnosis of morbidly adherent placenta through imaging (ultrasound color Doppler and MRI) allows for multidisciplinary planning to minimize potential maternal or neonatal morbidity and mortality. Also, proper counselling of patients regarding associated risks reduces maternal morbidity and mortality.