Background: A low placenta may now be located with absolute accuracy using transvaginal scanning. The procedure known as transperineal sonography (TPS) is quick, easy, safe, and gives the patient very little pain. The objective of the current study is the determination of the accuracy of transperineal ultrasound versus transvaginal ultrasound (TVS) in the diagnosis of placenta previa in late pregnancy. Patients and methods: In a prospective comparative study at Ain Shams University Maternity Hospital at Ultrasound Special Care Unit for the fetus using Medison sonoace R5 ultrasound 67 cases suspected to have placenta previa by trans-abdominal US were enrolled. Comparison between transperineal versus transvaginal US for having placenta previa diagnosis was judged by intraoperative visualization. Results: There was significant moderate agreement between intraoperative observation (golden test) and both transperineal ultrasound and tranvaginal ultrasound. The diagnostic accuracy was 92.5% (95%CI: 90.4-93.1) for tranperineal versus 97% (95%CI: 96.1-97.3) for the transvaginal. Mean “Verbal Descriptor Scale" assessment was significantly higher in transvaginal than in transperineal US (3.3±0.4 versus 1.3±0.4 respectively, p value <0.001). Conclusion: TPS and TVS are also useful methods that can be used in addition to transabdominal sonography to diagnose placenta previa. However, TPS proved to be superior than TVS due to reduced discomfort, the lack of specialist equipment, and the avoidance of vaginal penetration, particularly in situations where there is a danger of infection.