title: Emergency peripartum hysterectomy: results from the prospective Nordic Obstetric Surveillance Study (NOSS).
abstract: OBJECTIVE
  To assess the prevalence and risk factors of emergency peripartum hysterectomy.
  
  
  METHODS
  Nordic collaborative study.
  
  
  METHODS
  605 362 deliveries across the five Nordic countries.
  
  
  METHODS
  We 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.
  
  
  METHODS
  Emergency peripartum hysterectomy rate.
  
  
  RESULTS
  The 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).
  
  
  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.
authors.affiliation: Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Maija
authors.initials: M
authors.lastname: Jakobsson
authors.affiliation: Hyvinkää Hospital Area, Helsinki and Uusimaa Hospital District, Helsinki, Finland.
authors.forename: Anna-Maija
authors.initials: AM
authors.lastname: Tapper
authors.affiliation: Juliane Marie Centre, Department of Obstetrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Lotte Berdiin
authors.initials: LB
authors.lastname: Colmorn
authors.affiliation: Department of Gynecology and Obstetrics, Clinitec, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Pelle G
authors.initials: PG
authors.lastname: Lindqvist
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.|Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway.
authors.forename: Kari
authors.initials: K
authors.lastname: Klungsøyr
authors.affiliation: Department of Obstetrics and Gynecology, Holbaek Hospital, Holbaek, Denmark.|University of Copenhagen, Copenhagen, Denmark.
authors.forename: Lone
authors.initials: L
authors.lastname: Krebs
authors.affiliation: Department of Obstetrics and Gynecology, Haukeland University Hospital, Haukeland, Norway.|University of Bergen, Bergen, Norway.
authors.forename: Per E
authors.initials: PE
authors.lastname: Børdahl
authors.affiliation: Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.|Epidemiology and Methodological Support Unit, Department of Evaluation and Analysis, National Board of Health and Welfare, Stockholm, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Gottvall
authors.affiliation: Epidemiology and Methodological Support Unit, Department of Evaluation and Analysis, National Board of Health and Welfare, Stockholm, Sweden.|Department of Obstetrics and Gynecology, Institution of Clinical Sciences, University of Lund, Lund, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Källén
authors.affiliation: Department of Obstetrics and Gynecology, Landspitali University Hospital, Reykjavik, Iceland.
authors.forename: Ragnheiður I
authors.initials: RI
authors.lastname: Bjarnadóttir
authors.affiliation: Juliane Marie Centre, Department of Obstetrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Jens
authors.initials: J
authors.lastname: Langhoff-Roos
authors.affiliation: THL National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Mika
authors.initials: M
authors.lastname: Gissler
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D004630:Emergencies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D015994:Incidence; D008428:Maternal Mortality; D010921:Placenta Accreta / Q000453:epidemiology / Q000601:surgery*; D011159:Population Surveillance; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000601:surgery*; D011247:Pregnancy; D011273:Pregnancy, Prolonged / Q000453:epidemiology; D047928:Premature Birth / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D011644:Puerperal Disorders / Q000453:epidemiology / Q000601:surgery; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D050497:Stillbirth; D014597:Uterine Rupture / Q000453:epidemiology / Q000601:surgery*; D055815:Young Adult
keywords: Abnormally invasive placenta; cesarean section; emergency peripartum hysterectomy; near-miss complication; postpartum hemorrhage