Objective To analyze the high-risk factors, maternal and infant outcomes of emergency cesarean section in pregnant women with invasive placenta accreta spectrum disorders retrospectively and provide theoretical basis for exploring pregnancy management models and termination time for pregnant woman with invasive placenta accreta spectrum disorders.Methods A retrospective case-control study was conducted on pregnant women diagnosed with invasive placenta accreta spectrum disorders (the ultrasound score of placenta acrreta≥5, placental pathology revealed placenta increta or placenta percreta) from January 2018 to December 2022 at Chengdu Women and Children's Center Hospital. The relationship between perinatal variables and intraoperative bleeding in pregnant women, risk factors for emergency cesarean section in patients with invasive PAS and the correlation between gestational age and emergency cesarean section were analyzed. Results Gestational hypertension disease (GHD), intrahepatic cholestasis of pregnancy (ICP) and more than once of previous cesarean section had an increased risk of emergency cesarean section by 98%, 112% and 124%. While the BMI prepregnancy increases by 1 kg/m2, the risk of emergency cesarean section is reduced by 5% (OR: 0.95, CI: 0.82-0.98, P=0.038). Conclusion GHD, ICP and more than once of previous cesarean section are independent risk factors for invasive PAS emergency cesarean section. There is no significant linear correlation between emergency cesarean section and gestational age. Therefore, in order to reduce adverse fetal outcomes, it is recommended to extend the gestational age before 36 weeks of gestation as much as possible