The appropriateness of cesarean section as the route of delivery in pregnancies complicated by fatal fetal abnormalities was evaluated in an obstetric population of 47,924 deliveries during the years 1978-90. The incidence of fatal fetal abnormalities was 0.50% and did not change during the study period. The cesarean section rate was twice that in the whole obstetric population, and the procedure was performed mainly for inappropriate fetal indications. One-third of the sections were caused by antepartum or intrapartum fetal distress. After the advent of sophisticated real-time ultrasound equipment, the obstetric management of those cases seemed to increase, but later the incidence of cesarean sections for fetal indications decreased, from increased experience with assessing the prognosis of malformed fetuses and increased opportunities to examine the fetal karyotype. Some conservatism seems justified when choosing obstetric management of a malformed fetus before large, controlled, clinical studies become available.