Purpose of the study. To identify clinical-anamnestic and antenatal care predictors of emergency cesarean section (CS) in nulliparous women compared with planned operative delivery. Material and methods. A retrospective cohort study analyzed 350 delivery records of nulliparous women who underwent CS in 2022-2024 at the Tajik Research Institute of Obstetrics, Gynecology and Perinatology (tertiary-level hospital). The emergency CS group included 245 women corresponding to Robson TGCS groups I-II, operated on urgently during spontaneous or induced labor, or before labor onset due to urgent indications. The planned CS group included 105 nulliparous women delivered electively. Categorical variables were compared using Pearson’s chi-square test (χ2). Differences were considered statistically significant at p < 0.05. Research results. The mean maternal age was 24.7 ± 0.4 years in the emergency CS group versus 29.5 ± 0.5 years in the planned CS group (p < 0.05). Early reproductive age (18-24 years) was more frequent in emergency CS: 132/53.8 ± 3.2% vs 28/26.6 ± 4.3%, whereas late reproductive age (35-48 years) was more common in planned CS: 33/31.4 ± 4.5% vs 31/12.6 ± 2.1% (p < 0.05). Maternal anemia and urinary system diseases were significantly more prevalent in emergency CS (38.3 ± 3.1% and 27.0 ± 2.8%) than in planned CS (27.6 ± 4.4% and 19.0 ± 3.8%; p < 0.05). In contrast, a complicated obstetric-gynecological history was observed more often in the planned CS group (41.9 ± 2.4% vs 20.8 ± 1.9%). Antenatal care indicators demonstrated poorer early registration before 12 weeks in the emergency CS group (42.4% vs 51.1%; p < 0.05) and lower adherence to the recommended number of visits (7-8 visits): 25.7 ± 3.1% vs 43.3 ± 5.3% (p < 0.05). Conclusions. Emergency CS in nulliparous women is associated with younger maternal age, higher prevalence of anemia and urinary system diseases, and markers of insufficient antenatal care (later registration, fewer visits, and organizational deficiencies in referral and routing). These factors may serve as clinically relevant predictors of urgent operative delivery and targets for preventive interventions.