Background: Malaria is a major public health problem in sub-Saharan Africa and presents an enormous diagnostic challenge. Placenta histology is considered the gold standard of malaria diagnosis in pregnancy. Histological diagnosis of placenta malaria in an ongoing pregnancy is technically difficult and has limited applicability. Current diagnosis of malaria in pregnancy relies on peripheral venous blood microscopy; unfortunately very few studies have compared its accuracy to that of the gold standard, placenta histology. Similarly, though a few recent studies suggests that intradermal smear microscopy may be more accurate than peripheral venous blood microscopy in the diagnosis of malaria in pregnancy, there are no studies in Nigerian women that have assessed its accuracy in comparison to the gold standard. Objectives: The objectives of the study were to determine the accuracy of intradermal smear microscopy, peripheral venous blood microscopy and to compare their accuracies in the diagnosis of malaria in pregnancy. The cost effectiveness of both diagnostic tests were also compared. Patients and Methods: In a prospective comparative survey, four hundred and six consecutive pregnant Nigerian women were recruited. Four samples (intradermal blood smear, peripheral venous blood smear, cord blood smear and placenta histology) were examined for evidences of malaria parasites. Information relating to the use of intermittent preventive treatment with sulphadoxine/pyremethamine, history of fever attack, intrapartum pyrexia, maternal anaemia, birth asphyxia, congenital malaria, neonatal anaemia, low birth weights and patients' preference for the two techniques were obtained. The correlations of malaria parasitemia on intradermal smear microscopy and peripheral venous blood microscopy to malaria parasitization on placenta histology were analysed using the SPSS 16 version. Tests of statistical significance were done using the Chi square method at 95% confidence interval. Sensitivity, specificity and accuracy rates were used to assess the validity of both test method.