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The management of multiple pregnancy in women with a lower‐segment caesarean scar. Is a repeat caesarean section really the ‘safe’ option?

Summary. Multiple pregnancy occurring in a patient who has previously had a lower‐segment caesarean section is an unusual sequence of events. Retrospective analysis over an 11 ‐year period in Sheffield from 1975 to 1985, revealed 25 cases, a rate of 1 in 3300 deliveries. The caesarean section rate in this group of women rose from 20% (3/15) in the first six years to 70% (7/10) in the latter years for no obvious reason. This change in management did not produce any improvement in fetal outcome but there was an increase in maternal morbidity. This analysis and a review of available literature suggest that multiple pregnancy is not in itself an indication for elective repeat caesarean section.