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OBJECTIVE: To determine the diagnostic accuracy of ultrasound in detection of molar pregnancy taking histopathological findings as a gold standard. METHODS: This study was conducted in Khyber Teaching Hospital, Peshawar, Pakistan. All pregnant females of 15-45 years’ age; with clinical, biochemical suspicion and definite diagnosis of molar pregnancy were included in our study. Patients already diagnosed on histopathology as hydatidiform mole, missed miscarriage and invasive mole were excluded from the study. Informed consent, brief history, baseline Investigations, serum beta Human Chorionic Gonadotropin levels were obtained. Suspected cases of hydatidiform mole (n=212) on Transabdominal Ultrasound scans were referred to gynecologist for histopathological diagnosis and management. Histopathology of samples were compared to ultrasound report. Data was collected was analyzed by SPSS v.23.0. RESULTS: Mean age of patients was 29.04±8.23 years. Molar pregnancies were reported in 119 (56.13%) and 124 (58.49%) cases through ultrasound and histopathology respectively. Ultrasound findings suggestive of complete molar pregnancy in 79 (37.2%) cases, as compared to 85 (40.09%) cases by histopathology. Majority (n=35; 58.3%) of the molar pregnancy were found in patients having 31-40 years of age. Ultrasound and histopathology showed agreement in diagnosis of molar pregnancy in 103/156 (66%) cases and non-molar pregnancy in 40/56 (71.4%) cases. Sensitivity, specificity, positive predictive value, negative predictive value and overall diagnostic accuracy of Ultrasound in diagnosis of molar pregnancy were 66.03%, 71.43%, 86.55% 43.01% and 67.45% respectively. CONCLUSION: Overall diagnostic accuracy of ultrasound in diagnosis of molar pregnancy is 67.45% and may be used in early detection of molar pregnancy.