Objective: To evaluate a novel targeted devascularisation technique for placenta accreta spectrum (PAS). Design: Prospective observational study. Setting: Tertiary care centre in Saudi Arabia. Population: 67 pregnant women with PAS. Methods: Targeted devascularisation of the lateral uterine wall was performed during caesarean delivery. Main outcome measures: Uterine preservation, maternal morbidity. Results: Uterine preservation achieved in 95.5%. Mean blood loss was 1.57 ± 0.81 L; 82.1% required transfusion. Bladder injury occurred in 22.4%. Surgical outcomes improved over time. Conclusion: Targeted devascularization is a safe, effective uterus-sparing technique for PAS with low morbidity.