{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T07:14:08Z","timestamp":1793949248895,"version":"4.8.0"},"reference-count":28,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2019,9,26]],"date-time":"2019-09-26T00:00:00Z","timestamp":1569456000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Peripartum hysterectomy is usually undertaken in cases of life\u2010threatening obstetric hemorrhage to prevent the death of the mother. Near\u2010miss events are still under\u2010researched and inappropriate care continues to be a critical issue, even in countries with advanced obstetric surveillance systems. The aim of the present study was to estimate the prevalence, associated factors, management and intraoperative and postoperative complications of peripartum hysterectomy due to obstetric hemorrhage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>A prospective population\u2010based study has been conducted in six Italian regions covering 49% of births in Italy. The study population comprised all women aged 11\u201059\u00a0years undergoing peripartum hysterectomy, from September 2014 to August 2016, due to obstetric hemorrhage within 7\u00a0days of delivery. In each maternity unit a trained reference person reported incident cases using electronic data collection forms. The background population comprised all women who delivered in the participating regions during the study period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The overall peripartum hysterectomy prevalence was 1.09 per 1000 maternities, with a large variability among regions, ranging from 0.52 to 1.60. Previous cesarean section (relative risk [RR] 4.97, 95% CI 4.13\u20105.96), assisted reproductive technology (RR 5.99, 95% CI 4.42\u20108.11) multiple pregnancy (RR 5.03, 95% CI 3.57\u20107.09) and maternal age \u226535\u00a0years (RR 2.69, 95% CI 2.25\u20103.21) were the main associated factors for hysterectomy. The most common causes of peripartum hysterectomy were uterine atony (45.1%) and abnormally invasive placentation (40.2%). Intensive care unit admission was reported in 49.9% of cases, 16.8% of women suffered severe morbidity and 5 women died.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The rate of peripartum hysterectomy in Italy was three times higher compared with the UK, the Netherlands and the Nordic countries. The wide difference may be associated with women's characteristics, such as age at delivery and previous cesarean section, and with different management options leading to peripartum hysterectomy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.13727","type":"journal-article","created":{"date-parts":[[2019,9,14]],"date-time":"2019-09-14T02:29:08Z","timestamp":1568428148000},"page":"274-282","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Women undergoing peripartum hysterectomy due to obstetric hemorrhage: A prospective population\u2010based study"],"prefix":"10.1111","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4754-5385","authenticated-orcid":false,"given":"Alice","family":"Maraschini","sequence":"first","affiliation":[{"name":"National Center for Disease Prevention and Health Promotion Istituto Superiore di Sanit\u00e0\u2014Italian National Institute of Health Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5272-0638","authenticated-orcid":false,"given":"Ilaria","family":"Lega","sequence":"additional","affiliation":[{"name":"National Center for Disease Prevention and Health Promotion Istituto Superiore di Sanit\u00e0\u2014Italian National Institute of Health Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5780-0277","authenticated-orcid":false,"given":"Paola","family":"D'Aloja","sequence":"additional","affiliation":[{"name":"National Center for Disease Prevention and Health Promotion Istituto Superiore di Sanit\u00e0\u2014Italian National Institute of Health Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Buoncristiano","sequence":"additional","affiliation":[{"name":"National Center for Disease Prevention and Health Promotion Istituto Superiore di Sanit\u00e0\u2014Italian National Institute of Health Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Dell'Oro","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Foundation MBBM San Gerardo Hospital University of Milano\u2014Bicocca Monza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4607-2072","authenticated-orcid":false,"given":"Serena","family":"Donati","sequence":"additional","affiliation":[{"name":"National Center for Disease Prevention and Health Promotion Istituto Superiore di Sanit\u00e0\u2014Italian National Institute of Health Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Regional Obstetric Surveillance System Working Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,9,26]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"Evaluating the Quality of Care for Severe Pregnancy Complications: The WHO Near\u2010Miss Approach for Maternal Health","author":"World Health Organization","year":"2011"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2009.01.007"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12316"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60696-6"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13415"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001736"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2016.10.008"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-013-3079-2"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1479-828X.2010.01278.x"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2007.01507.x"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2009.09.003"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12644"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000296658.83240.6d"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-015-3790-2"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12080"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002494"},{"key":"e_1_2_10_18_1","unstructured":"Euro\u2010Peristat Project. 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