In this observational study, we will recruit 40 pregnant women under 40 years of age, each at least 32 weeks gestational age and having had at least one previous cesarean section. Participants will be enrolled from the outpatient department or labor ward of the Obstetrics and Gynaecology Department at PGIMER after completing detailed history-taking, clinical examination, and ultrasound, and after providing informed consent. The study will commence only after receiving approval from the Institute Ethics Committee, with collaboration from the Departments of Radiodiagnosis and Pathology.

Exclusion criteria include hemoglobinopathies or other hematological disorders, multiple gestations, cases requiring urgent surgical intervention before complete evaluation, and individuals unwilling to participate.

The study cohort will consist of two equal groups:

Placenta accreta group: 20 women diagnosed using PAS scoring, at 32–36 weeks gestation (mean ~34 weeks).

Control group: 20 women with at least one prior cesarean section, at 32–40 weeks gestation (mean ~36 weeks).

Both groups will be matched for age, parity (gravida), and weight. Hematologic parameters will be collected at admission, on the day of surgery (day 0), and on post-operative day 2. Angiogenic markers will be measured on the day of delivery for all participants. Placental volume will be assessed at enrollment using 3D ultrasonography performed by an expert.