Abstract INTRODUCTION: The objective of this study is to assess the diagnostic accuracy, reliability, and efficacy of elastosonography in the diagnosis of cesarean scar pregnancy. To this end, the present study will compare the elastosonography findings in patients with cesarean scar pregnancy with those obtained through definitive diagnostic methods and investigate the diagnostic potential of elastosonography. MATERIAL AND METHOD: This prospective cohort study was conducted at Mardin Training and Research Hospital between October 2023 and January 2024. Patients with a cesarean scar pregnancy between six and twelve weeks of gestation were evaluated. The stiffness and elasticity of the scar tissue were assessed using elastosonography, and the diagnostic accuracy of this method was evaluated by comparing the results with those obtained through definitive diagnostic procedures. RESULTS: In this study, the demographic and clinical characteristics of 61 patients with cesarean scar pregnancy (CSP) were analyzed. The mean age of the patients was 32 years, the mean gestational age was 8.4 weeks, the mean BMI was 27.2, the mean parity was 1.9, and the mean number of previous cesarean sections was 1.3. While the elasticity of the scar tissue decreased with increasing gestational week, no significant correlation was found between age, BMI, parity, and number of previous cesarean sections and elastosonography findings. The gestational sac strain ratio, myometrial shear wave velocity, and scar stiffness, as measured by elastosonography, were found to be significant in the diagnosis of CSP. Conversely, the beta-hCG and fetal heart rate parameters did not contribute significantly to the diagnosis. CONCLUSION: In conclusion, the results of this study indicate that elastosonography has the potential to serve as a diagnostic tool for the identification of pregnancies in cases of cesarean section scar. The findings indicate that elastosonographic parameters, including the gestational sac tension ratio, myometrium shear wave velocity, and scar stiffness, may prove useful in diagnosing pregnancy in a cesarean scar. Further research is required to ascertain the full clinical utility of this technique. However, this study provides valuable information on the diagnostic accuracy and reliability of elastosonography in the evaluation of pregnancy in a cesarean scar.