Background: The incidence of placenta accreta has increased dramatically over the last three decades, in concern with the increase in the cesarean delivery rate. Optimal management requires accurate prenatal diagnosis. Objectives: To identify the risk factors for the development of placenta previa accrete as compared to placenta noneaccrete and to evaluate the role of trans-abdominal color Doppler in diagnosis placenta previa accreta. Methods: Prospective interventional study done at gynecology and obstetrics department,Baghdad teaching hospital, NursingHome, Medicalcity, Baghdad, Iraq. During the twenty one month study period, 53woman all beyond 28week and all with ultrasound diagnosis of placenta previa were included in the study. Results: Of the 53 placenta previa cases,(ten women exhibited characteristic color Doppler imaging patterns highly specific for placenta accreta. One of them had false positive color Doppler imaging, and nine confirmed at cesarean section to have placenta accreta. Seven of them underwent emergency hysterectomy. Of the 43 women with negative color Doppler imaging results, two had placenta accreta required cesarean hysterectomy (false negative), and both were posterior placenta previa. However, there were two cases of placenta previa non accreta required cesarean hysterectomy because of uncontrollable hemorrhage (inertia). The sensitivity of color Doppler imaging in the diagnosis of placenta previa accreta was 81.8%, specificity was 97.6%, the positive and negative predictive value were 90% and 95.3% respectively. Conclusion: Previous C/S is a major risk factor for the development of placenta accretamainly repeated uterine operation, although both gravidity and curettage increase the incidence they were not reach statistical significance.