Background: Placenta accreta is considered a life-threatening condition and the main cause of maternal mortality, postpartum hysterectomy, admission to ICU, and an inadvertent laceration to intestine or bladder during cesarean section. Objectives: To evaluate the efficacy of transabdominal ultrasonography and color Doppler in prediction of placental myometrial invasion in patients with prior cesarean delivery. Patients and methods: This prospective study was conducted at El-Galaa teaching maternity hospital in ultrasound unit, emergency department, and operation theatre where 100 pregnant women with gestational age of 30 weeks or more whose placentae were anterior and previa with previous cesarean deliveries by Trans abdominal real-time imaging Results: Sensitivity, specificity, PPV, NPV, and accuracy of ultrasound in diagnosis of PA were 92.5%, 90.0%, 86.0%, 94.7%, and 91.0%, respectively. The detection of intraplacental lacunae has the highest positive predictive value (95.5%).with high sensitivity (92%). Conclusion: The presence of intraplacental lacunae had the highest sensitivity for detection of PA and the use of a two‐criteria system allowed a good compromise between sensitivity and specificity, with high PPV and NPV.