Objective To explore the value of transvaginal three-dimensional ultrasound in the early prediction of cesarean scar pregnancy. Methods A retrospective analysis was made on 142 cases of uterine scar pregnancy clinically diagnosed in our hospital from April 2016 to April 2018. All cases were examined by transvaginal three-dimensional ultrasound and transvaginal two-dimensional ultrasound before operation. The diagnostic accuracy of the two methods was compared, and the results of the diagnosis of cicatricial pregnancy after cesarean section, such as gestation sac type, block type, partial incision and partial uterine cavity type caesarean section, were calculated, and the sensitivity and specificity of the two methods were calculated. Results A total of 52 cases were diagnosed as cesarean scar pregnancy, including 22 cases of incision gestational sac type, 13 cases of mass type, 17 cases of partial incision and partial uterine cavity gestational sac type. The positive diagnostic coincidence rate of transvaginal two-dimensional ultrasound was 55.73% (34/61), and that of transvaginal three-dimensional ultrasound was 85.45% (47/55). The positive diagnostic coincidence rate of transvaginal three-dimensional ultrasound was higher than that of transvaginal two-dimensional ultrasound (P??0.05). The diagnostic rate of transvaginal three-dimensional ultrasonography for cesarean scar pregnancy of mass type, partial incision type and partial uterine cavity gestational sac type was higher than that of transvaginal two-dimensional ultrasonography (P?