BACKGROUND Emergency peripartum hysterectomy has remained a challenging and very life saving surgical procedure in obstetrics. Its indications are emerging. OBJECTIVE This was to determine the incidence, indications, and outcomes of emergency peripartum hysterectomy at a tertiary hospital in Nnewi, south-east Nigeria. METHODS A retrospective study of the case files of patients requiring an emergency peripartum hysterectomy between January 2000 and December 2009 was conducted. Emergency peripartum hysterectomy was defined as one performed for hemorrhage unresponsive to other treatment within 24 hours of delivery. The findings were analyzed using Epi info version 3.5.1. RESULTS During the 10-year period, there were 6,137 deliveries and 38 cases of emergency peripartum hysterectomies, giving an incidence of 6.2 per 1000 deliveries. Of the 38 hysterectomies, only 29 (76.3%) case files were available for analysis. The mean age of the patients was 28.1 ± 5.4 years and 22 (75.9%) patients were unbooked. There were four primigravidae (13.8%) while 25 (86.2%) were parous. The main indications for hysterectomy were placenta praevia 14 (48.3%) and uterine rupture 10 (34.5%). Subtotal hysterectomy was performed in majority (72.4%) of cases. The commonest postoperative morbidities were postoperative fever (37.9%), postoperative anemia (24.1%), and wound infection (20.7%). The maternal case fatality rate was 31.0%, while the perinatal mortality was 44.8%. The mean duration of hospital stay was 9.8 ± 2.4 days. CONCLUSIONS The incidence of emergency peripartum hysterectomy was high and majority of patients were unbooked. Placenta praevia has emerged as its primary indication. Booking for antenatal care, anticipation, prompt resuscitation, and early surgical intervention by a skilled surgeon are crucial.