Groin swelling in pregnancy can give rise to various diagnostic dilemmas. Inguinal hernia not uncommonly may present for the first time in pregnancy because of increase in intraabdominal pressure. It is 10 times less frequent in women than in men. The reported incidence is 1 in 3000. The other differential diagnosis including femoral hernia, enlarged lymph nodes, vascular aneurysm and subcutaneous lipoma. Congestion of the pelvic and iliac veins may give rise to round ligament varicosities mimicking inguinal hernia. The distinction between the two is difficulty clinically as symptoms and signs are similar. Ultrasound has proved to be a useful tool for differentiating round ligament varicosities from an inguinal hernia. The characteristic ultrasound picture includes a prominent venous plexus with dilated draining veins and typical bag of worms appearance. Round ligament varices require close monitoring during pregnancy as it can lead to rupture of varices or acute variceal thrombosis in peripartum period. This case highlights the potential difficulty in diagnosing inguinal swelling clinically in pregnancy. Ultrasonography can however clinch the diagnosis and prevent unnecessary surgery and its associated morbidity. Bilateral inguinal swelling is gravid state is not a common occurrence is obstetric practice. Bilateral round ligament varicosities may be mistaken for inguinal hernias in gravid patients because these conditions have similar presentations. It is very critical to differentiate between varicosities and hernias to avoid performing unnecessary surgery.