Background: Various imaging investigative protocols are used in cesarean section scar assessment such as Hysterography, sonography, saline infusion sonography and hysteroscopy. The role of ultrasound in visualization and detection of CS scar defect in non-pregnant females has been investigated. Two-dimensional transvaginal sonography is a precise imaging tool for measuring cesarean section scar thickness. Aim: To investigate in a comparative analytical manner the sonographic versus hysteroscopic diagnostic approaches for evaluation of the cesarean section scar. Methodology: It is a comparative cross-sectional clinical research trial conducted from June 2017 to May 2018. The research trial has recruited 70 female study subjects who have previous one cesarean delivery and visited Zagazig Outpatient Clinic. For all recruited Study subjects, detailed clinical history was taken, two-dimensional transvaginal ultrasound and doppler were used to evaluate scar thickness, location, vascular content, scar integrity and liability for distension by saline infusion. After ultrasound examination, a diagnostic hysteroscopy was used to comparatively evaluate -in relation to transvaginal ultrasound – the cesarean scar regarding the following: location, vascular content, integrity, distension liability. Results: Correlations between findings of US and hysteroscopy regarding Liability for distension, Integrity, Vascular content (Kappa agreement (SE) = 0.161 (0.128), 0.625 (0.095), 0.736 (0.082) consecutively. The comparative statistical analysis -between findings of US and hysteroscopy- showed no statistically significant difference as regard Scar location, Liability for distension, Integrity, Vascular content (p values =0.853, 0.216, 0.145, 0.864 consecutively). Conclusions: The current research effort has revealed that the sonography is more precise than the hysteroscopy in assessment of cesarean section scar thickness and scar defects being less invasive, less cost, and less complications).