Objective: To find the maternal and fetal morbidity and mortality in elective versus emergencycaesarean section. Design: Prospective Setting: Obstetrics and Gynaecology Unit-III, Nishtar Hospital, Multan.Period: One year. Material and methods: 150 patients who underwent caesarean section were evaluated for maternaland fetal complications. Results: Overall intra-operative complications rate was 8.67%. 12 out of 13 complicationsoccurred in emergency group. Postoperative complication was 34.66% and out of it emergency versus elective were90.38% vs 9.62% respectively. Similarly maternal mortality was 666/100,000 in emergency group. Fetal complicationswere also higher in emergency group in this study i.e. 22.2% vs 10.86% in emergency vs elective group. Similarlyprenatal morbidity was 15.04% in emergency group vs 8.10% in elective group. Fetal outcome was 100% in electivevs 94.69% in emergency caesarean section group. In one year period of study caesarean birth rate turned out as17.56% which is quite comparable to the rate in western countries but the rate does not reflect true caesarean birthin a given population because of the fact that this hospital being a tertiary referral center drains only complicated casesof the wide spread area of south Punjab. Higher incidence of caesarean birth can be reduced without increasing themorbidity and mortality. Furthermore, proper sterilization and prophylactic antibodies can reduce the infectious morbidityafter both emergency and elective caesarean section. Conclusions: Higher incidence of emergency caesarean sectionis a major contribution for increased rate of maternal and fetal morbidity and mortality in caesarean deliveries. This canbe reduced by improving the quality and availability of antenatal care of masses. We can also reduce the incidenceof caesarean birth without increasing perinatal morbidity and mortality.