Objective: We sought to determine the frequency, contributory factors, and morbidity of emergency obstetric hysterectomy (EOH) in our obstetric population, and suggest means for preventing this drastic surgical intervention. Methods: This was a retrospective review of the records of patients who had EOH during a 28-year period (1965–1993) at the Royal University Hospital, Saskatoon. We analyzed the patients' histories, operative reports, postoperative care, and perinatal outcomes. Results: There were 56 cases of EOH among a total of 30290 deliveries, representing an incidence of 1 in 541 deliveries (1.9 per 1000 deliveries). The mean age of the patients was 29.5 years. The surgical method applied in 50 cases (89.3%) was total hysterectomy while six (10.7%) had subtotal hysterectomy. Uterine atony was the leading indication for EOH (48.2%), followed by placenta accreta (26.8%), uterine rupture (10.7%), chorioamnionitis (10.7%), and extension of the lower uterine segment cesarean incision (3.6%). Hysterectomies performed for uterine atony was associated with grand multiparity (p < 0.0072), previous cesarean section (p < 0.5), chorioamnionitis (p < 0.26), previous postpartum hemorrhage (p < 0.08), oxytocin augmentation (p < 0.005), mean birthweight (p < 0.22), and tocolytic administration (p < 0.36). P values < 0.05 were considered significant. There was an associated high maternal morbidity: febrile morbidity, 55%; ureteric injuries, 41%; blood transfusion, 36%; pulmonary atelectasis, 32%; wound infection, 30%; psychological disturbance, 23%; and pelvic abscess, 16%, although maternal and perinatal mortalities were low (1.8%) and 6%, respectively). Conclusions: Uterine atony is a significant risk factor for EOH. Two-thirds of EOHs might have been prevented if adequate uterine contractility had been achieved at cesarean section or vaginal delivery. It should be stated clearly that prompt performance of obstetric hysterectomy before the patient's clinical condition deteriorates is the main key to success. Reduction of the frequency of uterine atony is achievable with the use of newer prostaglandin uterotonics. These agents may contribute to a reduction in the incidence of EOH. (J GYNECOL SURG 20:81)