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The prognosis of emergency cesarean section is poor for both the mother and child in developing countries. The respective impact of obstetrical and surgical factors has rarely been analyzed. This prospective study was carried out in 370 women (mean age, 30.5 years) who underwent emergency cesarean section at Principal Hospital in Dakar, Senegal, between January 1 and December 31, 1997. Fifty percent of these women had been transferred from an outside maternity clinic. Indications related to the mother (75% of cases) or fetus (25% of cases) were divided into two groups according to degree of emergency: absolute (n = 163) and relative (n = 207). Placental hematoma (n = 64) and fetus-pelvis size mismatching (n = 49) were the main indications in both groups. The technique chosen for initial anesthesia performed by a specialized nurse in most cases was either spinal anesthesia if there were no contraindications (50.8%) or general anesthesia (49.2%). There were 5 complications including 1 that was fatal (aspiration during intubation for general anesthesia). The postoperative maternal morbidity rate was low (n = 7) and outcome was favorable. A total of 7 patients (1.9%) died due to anesthesia-related events in 1 case and obstetrical factors in 6. Mortality in the absolute emergency group was significantly higher for women who were transferred from other clinics (p0.02). Child mortality (n = 87) occurred prior to delivery in two thirds of cases and after delivery in one third. Child mortality was significantly higher in the absolute emergency group (RR = 5.4; IC95% = 3.2-8.9, p10(-6)). Mother and child mortality rates were correlated with the severity of obstetrical manifestations and delay of care. Findings also showed that a well-organized care system lowers the operative risk of emergency cesarean section even in developing countries.