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Introduction: Placenta accreta spectrum is characterized by abnormal placental attachment to the uterine wall . This condition can complicate pregnancy and delivery due to increased risk of severe bleeding and difficulty in placenta removal . Aim and Objectives: To discuss a case of morbidly adherent placenta in a primigravida with prior risk factors. Material &Methods: Study Design- Hospital based Study Study Place-Dept. of OBGY, Katihar Medical college. Case Summary: A 32 year old primigravida with history of IVF treated with active married life of 10 year without any past surgical history, presented to labour ward with 9 months of amenorrhoea with pain abdomen. She had regular antenatal check up and her USG showed low lying placenta. She underwent elective caesarean section with significant amount of bleeding occured on attempt of removal of Placenta. To manage severe post partum haemorrhage bilateral internal iliac artery ligation was done. Result: This Case highlights the challenges associated with managing placente accreta in an primgravida .The decision was to perform bilateral internal iliac artery ligation was crucial in controlling PPH and preventing further complications as the uterus failed to contract even after medical management. Conclusion: Patients with prior history of IVF Procedure, elderly primigravidla are at increased risk of complication. Timely intervention and well - coordinated management are essential to improve maternal outcomes in such high risk pregnancies.