Objective: This study aimed to evaluate the correlation between ultrasound criteria for diagnosis of Placenta Accreta Spectrum (PAS) with intra-operative FIGO grading to ensure accurate prenatal US diagnosis.   Design: Descriptive Prospective cohort study.    Setting: Kasr Al-Ainy maternity Hospital - Fetal Medicine Unit. Subjects and methods: Sixty-four women in 3rd trimester of pregnancy diagnosed with low lying anterior placenta and had previous one or more cesarean deliveries were included. All patients were examined by ultrasound for criteria of abnormal placental implantation according to standardized description proposed by European Working group on PAS few days before the scheduled elective C.S. Then FIGO grading was done intra-operative followed by pathological confirmation of hysterectomy specimen. The main outcome was the correlation between prenatal ultrasound criteria of PAS and intra-operative FIGO grading of PAS are then histopathological confirmation was done. Results: A strong correlation was found between the presence of ultrasound placental lacunae (CC 0.429, P<0.001), loss of clear zone (CC 0.652, P <0.001) and myometrial thinning (CC 0.498, P <0.001) with intra-operative FIGO grading. While ultrasound Placental bulge (CC 0.265, P = 0.034) and Bladder wall interruption (CC 0.367, P 0.003) were moderately correlated with intra-operative FIGO grading. Conclusion: The surgical outcome and intraoperative FIGO grading are strongly correlated with the presence of placental lacunae, loss of clear zone and myometrial thinning and moderately correlated with Placental bulge and Bladder wall interruption ultrasound criteria. Funding: Self-Funded.    Synopsis: The surgical outcome and intraoperative FIGO grading are strongly correlated with the presence of placental lacunae, loss of clear zone and myometrial thinning and moderately correlated with placental bulge and bladder wall interruption in prenatal ultrasound.