• Maija Jakobsson, Anna-Maija Tapper, Lotte Berdiin Colmorn, Pelle G Lindqvist, Kari Klungsøyr, Lone Krebs, Per E Børdahl, Karin Gottvall, Karin Källén, Ragnheiður I Bjarnadóttir, Jens Langhoff-Roos, Mika Gissler, and NOSS study group.
• Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland.
• Acta Obstet Gynecol Scand. 2015 Jul 1; 94 (7): 745-754.

ObjectiveTo assess the prevalence and risk factors of emergency peripartum hysterectomy.DesignNordic collaborative study.Population605 362 deliveries across the five Nordic countries.MethodsWe collected data prospectively from patients undergoing emergency peripartum hysterectomy within 7 days of delivery from medical birth registers and hospital discharge registers. Control populations consisted of all other women delivering on the same units during the same time period.Main Outcome MeasuresEmergency peripartum hysterectomy rate.ResultsThe total number of emergency peripartum hysterectomies reached 211, yielding an incidence rate of 3.5/10 000 (95% confidence interval 3.0-4.0) births. Finland had the highest prevalence (5.1) and Norway the lowest (2.9). Primary indications included an abnormally invasive placenta (n = 91, 43.1%), atonic bleeding (n = 69, 32.7%), uterine rupture (n = 31, 14.7%), other bleeding disorders (n = 12, 5.7%), and other indications (n = 8, 3.8%). The delivery mode was cesarean section in nearly 80% of cases. Previous cesarean section was reported in 45% of women. Both preterm and post-term birth increased the risk for emergency peripartum hysterectomy. The number of stillbirths was substantially high (70/1000), but the case fatality rate stood at 0.47% (one death, maternal mortality rate 0.17/100 000 deliveries).ConclusionsA combination of prospective data collected from clinicians and information gathered from register-based databases can yield valuable data, improving the registration accuracy for rare, near-miss cases. However, proper and uniform clinical guidelines for the use of well-defined international diagnostic codes are still needed.© 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

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