Background: Placenta praevia is one of the leading causes of antepartum haemorrhage usually responsible for significant maternal & fetal morbidity & mortality. Now a day, there is rising trend of caesarean section with parallel rise in placenta praevia specially the major variety where placenta lies in the lower uterine segment partially or completely covering the cervical os. Objective: To see the maternal and perinatal outcome of ultrasonographically diagnosed cases of major variety of placenta praevia with previous caesarean section. Methods: It was a cross sectional descriptive type of observational study conducted in the Obs & Gynae Department of Mymensingh Medical College, Mymensingh over the period of six months from July, 2017 to December, 2017. Total 50 patients were selected for this study after fulfilling the inclusion criteria and diagnosed as major types of placenta praevia by ultrasonography. A purposive sampling technique was applied for selecting the patient with previous caesarean section. Data analysis was implemented using SPSS version 22. Results: The study result shows that 36% cases were Type III placenta praevia and 52% were central placenta praevia. Among 50 patients 54% patients were presented with history of previous one caesarean section & 32% had previous two caesarean section. 50.0% cases of type III & 80.8% cases of central placenta praevia with previous caesarean section needed peripartum hysterectomy. Out of 50 patients, 11 patients were complicated with urinary bladder injury, PPH occurred in 4 patients & 2 patients needed ICU support. That patient who needed hysterectomy massive blood transfusion was required. In this study no maternal mortality was observed. Regarding fetal outcome, 88% babies were alive & 12% were stillborn. Almost two third (66%) neonates were deliverd before term & 08 neonates were transferred to NICU. Conclusion: Placenta praevia is a matter of concern for the obstetrician due to devastating haemorrhage & adverse maternal & fetal outcome. Patients with major variety of placenta praevia with history of caesarean section are regarded as high risk pregnancy & these patients should be managed in the tertiary level hospital by multidisciplinary approach in presence of skilled obstetrician, expert anaesthesiologist, neonatologist, urologist along with all logistical support.