Background: Caesarean section rates continue to rise worldwide, and emergency caesarean delivery is typically undertaken to avert serious maternal or fetal complications. The spectrum of indications leading to emergency caesarean section varies across countries and institutions, and local data from Bangladeshi tertiary hospitals remain limited. This study aimed to determine the common indications for emergency caesarean section among women managed at Kurmitola General Hospital, Dhaka. Methods: This cross-sectional observational study was conducted in the Department of Obstetrics and Gynaecology, Kurmitola General Hospital, from July 2019 to December 2019. One hundred women with a singleton pregnancy beyond 28 weeks who underwent emergency caesarean section were enrolled by purposive sampling. Data were collected using a pre-tested, observation-based questionnaire and analysed using SPSS version 23. Results: The highest proportion of mothers (62%) were aged 21-25 years, with a mean age of 24.63±5.31 years. Forty-three percent were primigravida, and 54% had a gestational age of 37 weeks or more. Among fetal indications, fetal distress was the leading cause (22%), followed by severe intrauterine growth restriction (5%) and cord prolapse (1%). Among maternal indications, obstructed labour or failure to progress accounted for 21% of cases, malpresentation and pregnancy-induced hypertension each accounted for 13%, antepartum haemorrhage for 11%, previous caesarean section with scar tenderness for 9%, failed induction for 7%, and primary dysfunctional labour and cephalopelvic disproportion each for 4%. Conclusion: Fetal distress was the single most important indication for emergency caesarean section, while obstructed labour, pregnancy-induced hypertension and antepartum haemorrhage represented the principal maternal indications at this tertiary care center.