background: inguinal hernia in females is rare. At the time of pregnancy, a rare condition can evolve, round ligament varicosities, which is difficult to differentiate for the inguinal hernia on clinical bases. Ultrasonography with Doppler study differentiates the two conditions. Round ligament varicosities disappear spontaneously after delivery, while inguinal hernia needs surgical repair. This study aimed to highlight a cause of groin swelling in females during pregnancy, round ligament varicosities, and the feasibility of inguinal hernia repair during the elective cesarean section. Patients and methods: A prospective study of 17 pregnant patients presented with inguinal swelling. Ultrasonography was the cornerstone investigation for these patients that revealed round ligament varicosities in most patients and only four inguinal hernia cases. Patients with round ligament varicosities managed conservatively. Patients with hernia offered to repair the hernia during the cesarean section. Results: 17 pregnant patients presented with reducible inguinal swelling with impulse on cough. Most patients 14/17 presented with inguinal swelling without pain, while 3/17 patients had inguinal swelling and pain. The total patients with inguinal hernias were 4 patients; two of them were diagnosed before the occurrence of the pregnancy, and two patients during pregnancy. Thirteen patients with inguinal swelling had round ligament varicosities by ultrasound examination. Conclusion: The diagnosis of an inguinal hernia depending on the clinical picture only during pregnancy may be misleading in most cases. Concomitant preperitoneal inguinal hernioplasty with cesarean section is feasible. Keywords: inguinal swelling, round ligament varicosities, inguinal hernia.