The Efficacy of a Temporary Sub-Placental Uterine Tourniquet in Minimizing Intraoperative Blood Loss in Management of Placenta Accreta Spectrum Disorder by a Retrograde Cesarean Hysterectomy (Bladder Last)

Inclusion Criteria: * Gestational age: pregnancy completing 35 weeks or more. * Previous one or more cesarean delivery. * Current pregnancy complicated by Placenta Accreta Spectrum Disorder candidate for cesarean hysterectomy either total or partial Placenta Accreta. (i.e. Total: Most of the placenta is adherent to the myometrium with no plane of cleavage. Partial: 2-3 cotyledons are only adherent to the myometrium with no plane of cleavage at these cotyledons) * Elective termination of pregnancy. * Preoperative Hemoglobin ≥ 10 g/dl Exclusion Criteria: * Patients who refuse to participate in the study. * Women with history of a concomitant chronic or a pregnancy associated medical disorder eg. Gestational diabetes, hypertension, cardiac or renal disease. * Presence of a concomitant uterine pathology (eg. Uterine fibroid) * Premature rupture of membranes. * Cases misdiagnosed as placenta accreta by ultrasound preoperatively, and spontaneous full placental separation occurred intraoperative or as total/partial accreta and found to be focal accreta intraoperative. * Cases requiring preoperative blood transfusion.