Emergency peripartum hysterectomy: results from the prospective Nordic Obstetric Surveillance Study (NOSS)

Research output: Contribution to journalArticle


Objective: To assess the prevalence and risk factors of emergency peripartum hysterectomy. Design:Nordic collaborative study. Population605362 deliveries across the five Nordic countries. Methods: We collected data prospectively from patients undergoing emergency peripartum hysterectomy within 7days 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 measures: Emergency peripartum hysterectomy rate. Results: The total number of emergency peripartum hysterectomies reached 211, yielding an incidence rate of 3.5/10000 (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 0.17/100000 deliveries). Conclusions: A 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.


  • Maija Jakobsson
  • Anna-Maija Tapper
  • Lotte Berdiin Colmorn
  • Pelle G. Lindqvist
  • Kari Klungsoyr
  • Lone Krebs
  • Per E. Bordahl
  • Karin Gottvall
  • Karin Källén
  • Ragnheiour I. Bjarnadottir
  • Jens Langhoff-Roos
  • Mika Gissler
External organisations
  • Socialstyrelsen / Swedish National Board of Health and Welfare
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Obstetrics, Gynecology and Reproductive Medicine


  • Abnormally invasive placenta, cesarean section, emergency peripartum, hysterectomy, postpartum hemorrhage, near-miss complication
Original languageEnglish
Pages (from-to)745-754
JournalActa Obstetricia et Gynecologica Scandinavica
Issue number7
Publication statusPublished - 2015
Publication categoryResearch