Rising global incidence of peripartum hysterectomy, how to address this challenge? An invited review by the European Board and College of Obstetrics and Gynaecology (EBCOG).

Peripartum hysterectomy (PH), the surgical removal of the uterus during the peripartum period, is a rare but potentially life‑saving intervention for severe obstetric complications such as major haemorrhage, uterine rupture, and placenta accreta spectrum (PAS). As a maternal near‑miss event, PH carries substantial maternal and neonatal morbidity, mortality, and long‑term psychological impact. Data from the European INOSS network report an incidence of pH of 5.2 per 10,000 births, with notable variation between countries. Uterine atony and PAS are the leading indications, while major risk factors include advanced maternal age, multiparity, and especially prior caesarean section due to its association with abnormal placentation. Management of severe obstetric haemorrhage follows a multidisciplinary, stepwise process from medical therapy and conservative surgical techniques to hysterectomy when necessary. Differences in clinical definitions, access to interventional radiology, and availability of specialized centres affect comparability and outcomes. Improving maternal outcomes and reducing preventable PH requires strengthened population‑based surveillance, standardized definitions and guidelines, multidisciplinary training, and structured psychosocial follow‑up.