Background. Emergency cesarean section (CS) in nulliparous women is more often driven by acute obstetric complications and may be associated with poorer perinatal outcomes and prolonged postoperative hospitalization. Purpose of the study. To evaluate perinatal outcomes and early postoperative results in nulliparous women undergoing emergency CS compared with planned CS. Material and methods. A retrospective analysis of 350 delivery records (2022-2024) was conducted in a tertiary-level hospital. The emergency CS group included 245 women and the planned CS group included 105 women. The mean age in the total sample was 26.1 ± 0.3 years (24.7 ± 0.4 years in the emergency CS group and 29.5 ± 0.5 years in the planned CS group). Categorical variables were compared using Pearson’s chi-square test (χ2). Differences were considered statistically significant at p < 0.05. Research results. In the emergency CS group, hypertensive pregnancy complications (severe and moderate preeclampsia) and amniotic fluid volume disorders (polyhydramnios and oligohydramnios) were more frequent (p < 0.05). Complications observed only in the emergency CS group included partial placental abruption and prelabor rupture of membranes. The leading indications for emergency CS were obstructed labor (19.5%), fetal distress (16.3%), failed labor stimulation (7.3%), placental abruption (6.1%), and combined factors. Perinatal outcomes after emergency CS were characterized by a higher rate of moderate asphyxia (24.0% vs 5.7%), severe asphyxia occurring only in the emergency CS group (1.6%), a higher proportion of newborns with Apgar scores 4-6 at 1 minute (24.0% vs 5.7%; p < 0.001), and a tendency toward higher fetal growth restriction (6.1% vs 4.7%; p < 0.05). Postoperative complications (endometritis, metroendometritis, seroma, uterine hypotonia) and pathological blood loss were predominantly noted after emergency CS. Hospital stay of 11-16 days was more common in the emergency CS group (11.0% vs 3.8%; p < 0.001). Conclusions. Emergency CS in nulliparous women is associated with a more severe gestational and intrapartum profile, less favorable early perinatal indicators, and longer postoperative hospitalization.