Introduction: In low-income countries, caesarean sections are not always accessible even when they are clearly indicated. Caesarean Section (CS) is a major life saving surgical procedure and it is associated with decrease in maternal and neonatal morbidity and mortality, however, these benefits are not realised with higher levels of CS birth. The aim of this study was to assess the risk factors for emergency CS among term mothers with two or more previous CS scars delivering in Mulago National Referral Hospital in Kampala, Uganda. Methods: This was a case-control study. The cases were term mothers with two or more previous CS scars who were delivered by emergency CS whereas controls were term mothers delivered by elective CS. The cases and controls were recruited in a ratio of 1:1. A structured questionnaire was used to collect the data on 256 respondents. Data was analysed using SPSS version 23.0. Univariable, bivariable and multivariable analysis were carried out. The study received approval from the School of Medicine Research and Ethics committee (SOMREC), Makerere University. Administrative approval was also obtained from Mulago National Referral Hospital administration and written signed informed consent forms from the study participants. Results: A descriptive analysis of 256 women shows that most women, 33.2% (85/256) were of age group 21-25 years. Most women: had attained primary level of education, 36.7% (94/256); were urban dwellers, 69.5% (178/256); and were married, 75.8% (194/256). Multivariable analysis showed that: women aged 31-35 years and had 2 or more previous CS had higher odds of delivery by emergency CS as compared to elective CS (AOR=5.17, CI: 1.32-9.20, p<0.05); women who had had four pregnancies were less likely to deliver by emergency CS as compared to elective CS (AOR=0.18, CI: 0.06-0.55, p<0.01); the women who were admitted in labour in the hospital had higher odds of delivery by emergency CS than elective CS, (AOR=5.87, CI: 2.23-9.09, p<0.001); and those from households of high socio-economic status were less likely to deliver by emergency CS as compared to those from households of low socio-economic status, (AOR=0.19, CI: 0.06-0.63, p<0.01). Conclusion: After final adjustment at multivariable analysis, the risk factors found to be significantly associated with emergency CS among mothers with two or more previous scars were; older age, having five pregnancies, admission in labour, and low socio-economic status.

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