Objective: to determine maternal outcome with conservative surgery versus hysterectomy in pregnant women with placenta accreta spectrum according to operative time, intraoperative blood loss, need for blood transfusion, postoperative complications, and hospital stay. 
Design: prospective cross section study.
Setting: Mansoura University Hospitals.
Patients : 100 pregnant women with a diagnosis of placenta accrete spectrum who underwent conservative surgery and hysterectomy in the Department of Obstetrics and Gynecology, Mansoura University Hospitals.  
Interventions: Patients were divided into two groups; group 1 (n = 50) conservative and group 2 (n =50) hysterectomy at 1:1 ratio. 
Measurements and Main Results: There was a highly significant difference among both groups as regards operative time, need for blood products transfusion, blood loss, hemoglobin assessment after surgery, and postoperative complications. In conservative group, the mean operative time (min) was 140.70 ± 54.986, packed RBCs units was 2.86 ± 1.750, plasma units were 1.62 ± 1.510, blood loss 1580 ± 321 ml, mean hemoglobin before and after surgery was 10.71 ± 0.835 and 10.12 ± 0.779, and none had Bladder injury. In hysterectomy group, the mean operative time (min) was 267.60 ± 48.469, packed RBCs units was 5.94 ± 2.683, plasma units were 5.22 ± 2.613, and blood loss 2343 ± 665.4 ml, mean hemoglobin before and after surgery was 10.66 ± 0.616 and 9.72 ± 0.856, and 10% had Bladder injury.  
Conclusions: conservative surgery (preservation of the uterus) is a suitable treatment of placenta accrete spectrum especially in communities like Egypt in which women want to preserve fertility and refuse hysterectomy but the woman must be diagnosed during pregnancy and admitted before surgery to tertiary care hospital to be operated under care of multidisciplinary team expert in dealing with this condition with possibility of hysterectomy if needed.