{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T09:12:14Z","timestamp":1790845934565,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2020,5,21]],"date-time":"2020-05-21T00:00:00Z","timestamp":1590019200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Peripartum hysterectomy is a surgical procedure performed for severe obstetric complications such as major obstetric hemorrhage. The prevalence of peripartum hysterectomy in high\u2010resource settings is relatively low. Hence, international comparisons and studying indications and associations with mode of birth rely on the use of national obstetric survey data. Objectives were to calculate the prevalence and indications of peripartum hysterectomy and its association with national cesarean section rates and mode of birth in nine European countries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>We performed a descriptive, multinational, population\u2010based study among women who underwent peripartum hysterectomy. Data were collected from national or multiregional databases from nine countries participating in the International Network of Obstetric Survey Systems. We included hysterectomies performed from 22 gestational weeks up to 48\u00a0hours postpartum for obstetric hemorrhage, as this was the most restrictive, overlapping case definition between all countries. Main outcomes were prevalence and indications of peripartum hysterectomy. Additionally, we compared prevalence of peripartum hysterectomy between women giving birth vaginally and by cesarean section, and between women giving birth with and without previous cesarean section. Finally, we calculated correlation between prevalence of peripartum hysterectomy and national cesarean section rates, as well as national rates of women giving birth after a previous cesarean section.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1302 peripartum hysterectomies were performed in 2\u00a0498\u00a0013 births, leading to a prevalence of 5.2 per 10\u00a0000 births ranging from 2.6 in Denmark to 10.7 in Italy. Main indications were uterine atony (35.3%) and abnormally invasive placenta (34.8%). Relative risk of hysterectomy after cesarean section compared with vaginal birth was 9.1 (95% CI 8.0\u201010.4). Relative risk for hysterectomy for birth after previous cesarean section compared with birth without previous cesarean section was 10.6 (95% CI 9.4\u201012.1). A strong correlation was observed between national cesarean section rate and prevalence of peripartum hysterectomy (\u03c1\u00a0=\u00a00.67, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Prevalence of peripartum hysterectomy may vary considerably between high\u2010income countries. Uterine atony and abnormally invasive placenta are the commonest indications for hysterectomy. Birth by cesarean section and birth after previous cesarean section are associated with nine\u2010fold increased risk of peripartum hysterectomy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.13892","type":"journal-article","created":{"date-parts":[[2020,5,2]],"date-time":"2020-05-02T09:02:14Z","timestamp":1588410134000},"page":"1364-1373","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":48,"title":["Epidemiological analysis of peripartum hysterectomy across nine European countries"],"prefix":"10.1111","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6078-1185","authenticated-orcid":false,"given":"Athanasios F.","family":"Kallianidis","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Leiden University Medical Center Leiden the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4754-5385","authenticated-orcid":false,"given":"Alice","family":"Maraschini","sequence":"additional","affiliation":[{"name":"National Center for Disease Prevention and Health Promotion Istituto Superiore di Sanit\u00e0 \u2014 Italian National Institute of Health Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jakub","family":"Danis","sequence":"additional","affiliation":[{"name":"1st Department of Obstetrics and Gynecology Faculty of Medicine Comenius University Bratislava Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7570-2822","authenticated-orcid":false,"given":"Lotte B.","family":"Colmorn","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Rigshospitalet University Hospital Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6561-3321","authenticated-orcid":false,"given":"Catherine","family":"Deneux\u2010Tharaux","sequence":"additional","affiliation":[{"name":"Inserm U1153 Obstetric, Perinatal and Pediatric Epidemiology Research Team Center for Epidemiology and Statistics Sorbonne Paris Cite Paris University Paris France"}],"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 \u2014 Italian National Institute of Health Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8254-7525","authenticated-orcid":false,"given":"Mika","family":"Gissler","sequence":"additional","affiliation":[{"name":"Information Services Department THL Finnish Institute for Health and Welfare Helsinki Finland"},{"name":"Department of Neurobiology, Care Sciences and Society Karolinska Institute Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0075-8375","authenticated-orcid":false,"given":"Maija","family":"Jakobsson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Hyvink\u00e4\u00e4 hospital HUCH University of Helsinki Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1984-4575","authenticated-orcid":false,"given":"Marian","family":"Knight","sequence":"additional","affiliation":[{"name":"National Perinatal Epidemiology Unit University of Oxford Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Kristufkova","sequence":"additional","affiliation":[{"name":"1st Department of Obstetrics and Gynecology Faculty of Medicine Comenius University Bratislava Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1652-8235","authenticated-orcid":false,"given":"Pelle G.","family":"Lindqvist","sequence":"additional","affiliation":[{"name":"Clinical Science and Education Department of Obstetrics and Gynecology Karolinska Institute Sodersjukhuset Hospital Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7420-5020","authenticated-orcid":false,"given":"Griet","family":"Vandenberghe","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Ghent University Hospital Ghent Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9890-9145","authenticated-orcid":false,"given":"Thomas","family":"Van Den Akker","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Leiden University Medical Center Leiden the Netherlands"},{"name":"National Perinatal Epidemiology Unit University of Oxford Oxford UK"},{"name":"Athena Institute VU University Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"INOSS (the International Network of Obstetric Survey Systems)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,5,21]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.14833"},{"key":"e_1_2_10_3_1","unstructured":"Evaluating the quality of care for severe pregnancy complications: the WHO near\u2010miss approach for 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