Background: Placenta accreta spectrum (PAS) is an important cause of severe maternal morbidity, particularly among women presenting with antepartum haemorrhage (APH). Early identification of women at increased risk may facilitate timely referral and appropriate obstetric planning. This study aimed to identify predictors of PAS among women presenting with APH. Methods: This retrospective observational study was conducted in the Department of Obstetrics and Gynaecology, Sylhet Women's Medical College Hospital, Sylhet, Bangladesh, from January to December 2025. A total of 110 women presenting with APH after 28 weeks of gestation admitted to the Department during the study period were included. Results: Among 110 women, 25 (22.7%) had PAS. Significant associations were observed with maternal age ≥35 years, multiparity, ≥2 previous cesarean deliveries, previous uterine surgery, previous dilatation and curettage, placenta previa, anterior placenta, recurrent APH, and multiple ultrasonographic features suggestive of PAS. On multivariable analysis, ≥2 previous cesarean deliveries (adjusted OR=5.76, 95% CI: 2.01–16.53), placenta previa (adjusted OR=6.92, 95% CI: 2.41–19.86), and ≥2 suggestive ultrasonographic features (adjusted OR=18.64, 95% CI: 5.02–69.19) were independent predictors of PAS. Cesarean hysterectomy, blood transfusion, ICU admission, preterm delivery, and low birth weight were significantly more common among women with PAS. Conclusion: PAS was relatively common among women presenting with APH, particularly those with previous cesarean delivery, placenta previa, and characteristic ultrasonographic findings. Early identification of these risk factors may help improve antenatal risk stratification and obstetric preparedness.