{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T01:53:44Z","timestamp":1789523624907,"version":"build-2803163510"},"reference-count":29,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2021,3,14]],"date-time":"2021-03-14T00:00:00Z","timestamp":1615680000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Peripartum hysterectomy is applied as a surgical intervention of last resort for major obstetric hemorrhage. It is performed in an emergency setting except for women with a strong suspicion of placenta accreta spectrum (PAS), where it may be anticipated before cesarean section. The aim of this study was to compare management strategies in the case of obstetric hemorrhage leading to hysterectomy, between nine European countries participating in the International Network of Obstetric Survey Systems (INOSS), and to describe pooled maternal and neonatal outcomes following peripartum hysterectomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>We merged data from nine nationwide or multi\u2010regional obstetric surveillance studies performed in Belgium, Denmark, Finland, France, Italy, the Netherlands, Slovakia, Sweden and the UK collected between 2004 and 2016. Hysterectomies performed from 22 gestational weeks up to 48\u00a0h postpartum due to obstetric hemorrhage were included. Stratifying women with and without PAS, procedures performed in the management of obstetric hemorrhage prior to hysterectomy between countries were counted and compared. Prevalence of maternal mortality, complications after hysterectomy and neonatal adverse events (stillbirth or neonatal mortality) were calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1302 women with peripartum hysterectomy were included. In women without PAS who had major obstetric hemorrhage leading to hysterectomy, uterotonics administration was lowest in Slovakia (48\/73, 66%) and highest in Denmark (25\/27, 93%), intrauterine balloon use was lowest in Slovakia (1\/72, 1%) and highest in Denmark (11\/27, 41%), and interventional radiology varied between 0\/27 in Denmark and Slovakia to 11\/59 (79%) in Belgium. In women with PAS, uterotonics administration was lowest in Finland (5\/16, 31%) and highest in the UK (84\/103, 82%), intrauterine balloon use varied between 0\/14 in Belgium and Slovakia to 29\/103 (28%) in the UK. Interventional radiology was lowest in Denmark (0\/16) and highest in Finland (9\/15, 60%). Maternal mortality occurred in 14\/1226 (1%), the most common complications were hematologic (95\/1202, 8%) and respiratory (81\/1101, 7%). Adverse neonatal events were observed in 79\/1259 (6%) births.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Management of obstetric hemorrhage in women who eventually underwent peripartum hysterectomy varied greatly between these nine European countries. This potentially life\u2010saving procedure is associated with substantial adverse maternal and neonatal outcome.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14113","type":"journal-article","created":{"date-parts":[[2021,3,15]],"date-time":"2021-03-15T01:49:01Z","timestamp":1615772941000},"page":"1345-1354","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Management of major obstetric hemorrhage prior to peripartum hysterectomy and outcomes across nine European countries"],"prefix":"10.1111","volume":"100","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 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"}]},{"given":"Lotte B.","family":"Colmorn","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Rigshospitalet University Hospital Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Deneux\u2010\u00a0Tharaux","sequence":"additional","affiliation":[{"name":"Obstetric, Perinatal and Pediatric Epidemiology Research Team Center for Epidemiology and Statistics Sorbonne Paris Cite Inserm U1153 Paris Descartes 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 Italian National Institute of Health Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"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"}]},{"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"}]},{"given":"Marian","family":"Knight","sequence":"additional","affiliation":[{"name":"National Perinatal Epidemiology Unit Nuffield Department of Population Health 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 Karolinska Institute Department of Obstetrics and Gynecology Sodersjukhuset Hospital Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"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 Nuffield Department of Population Health University of Oxford Oxford UK"},{"name":"Athena Institute, VU Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"INOSS (the International Network of Obstetric Survey 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