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AIM - To report a case of rare occurrence of Placenta accreta spectrum (PAS) or adherant placenta in a nulliparous women with no significant prior risk factor after spontaneous abortion at 20 weeks of pregnancy,and its succefull conservative management ,after failed attempts of surgical evacuation,finally saving intact uterus for future fertility. BACKGROUND -Placenta accreta spectrum (PAS) refers to abnormal adherence of placental villi to the underlying myometrium beyond the confines of endometrium,completely or partially.women at greater risk of PAS are those who have myometrial damage caused by cesarean section or uterine curettage or any uterine surgery involving endometrium.PAS or invasive RPOC stands out as one of the most significant complication in pregnancy,capable of causing maternal morbidity and mortality,compromising future fertility.Although recognised obstetric risk factors allow the identification of most cases during antepartum period,the diagnosis is occasionally discovered at the time of delivery of placenta. CASE REPORT -we here present a rare case of successful conservative management of retained adherant placenta,in a nulliparous 31 years old patient with previous only one first trimester spontaneous abortion with single episode of dilation and curettage .Last abortion was at around 20 weeks of gestation ,which was managed elsewhere ,placenta did not expell completely after expulsion of foetus ,which was missed at that time.The final diagnosis of placenta accreta was made even after repeated attempts of evacuation of placenta elsewhere.Later MRI diagnosed large invasive RPOC breaking the junctional zone. she had episodes of torrential bleeding per vaginum requiring hospital admissions.In view of conserving uterus for future fertility,injection methotrexate regimen was started,giving us excellent outcome.the intact uterus was saved successfully for future fertility.The placenta was expelled completely as a cast like tissue. CONCLUSION - selected cases of morbidly adherent placenta can be succefully managed conservatively.Methotrexate may not only enhance autolysis,but Can also help in complete expulsion of retained placenta.