Introduction: The increase in the rate of caesarean sections has led to  increase of potentially life threatening complications such as placenta accreta, low-lying placenta and rupture uterus, as well as, surgical morbidity. Placenta accrete spectrum  is a condition of abnormal placental invasion on which the placenta invades beyond the decidua basalis. Morbidly adherent placenta represents a spectrum of disorders characterized by abnormal penetration of the placenta into the uterine wall.  
Objectives: this hospital based cohort study was conducted at obstetrics and gynecology department at mansoura university hospitals  from September 2022 to September 2023 aiming to formulate ascoring system to assess the degree of placenta accrete spectrum before decision of conservative management of placenta accrete spectrum. 
Methods: Pregnant females in the third trimester  of pregenancy with history of past cesarean section and diagnosed to have placenta accrete with 2D ultrasound and we intend to do conservative management, full history was taken, investigation, ultrasound and Doppler was done. 
Results: Integrated score is highly sensitive for prediction of placenta accreta spectrum (71.9%) and specificity 64.9% and cut off level is 8.5 also positive predicitive value is 63.9% and negative predicitive value is 72.7% and accuracy of the score is 68.1% .  
Conclusion:  The study's implications for practice are profound. The integrated scoring system, by combining various parameters and ultrasound criteria, has the potential to aid clinicians in assessing PAS severity before choosing management strategies. This is particularly relevant when considering conservative approaches. The study's findings and the consistency of results with other related research enhance the credibility and applicability of the prediction model. In practice, the prediction model can assist healthcare professionals in identifying high-risk cases of PAS, allowing for informed decisions about conservative management options.