Placenta accreta spectrum (PAS) presents complex surgical challenges requiring accurate antenatal assessment, individualised planning and multidisciplinary care. This presentation reviews operative strategies, including fetal delivery without placental disruption, caesarean hysterectomy, urinary tract protection and selected uterine-preserving approaches. It addresses major haemorrhage management, surgical adjuncts and current evidence on delivery timing and conservative management, with emphasis on surgical judgement and reducing maternal morbidity.