Objective. To determine the incidence and risk factors of early postpartum hysterectomy at the University Hospital in Vienna. Design. Retrospective case–control study. Setting. General Hospital Vienna, a tertiary referral center. Population. All 15,858 women who gave birth between 1st January 2003 and 31st December 2008. Methods. Analysis of all cases of early postpartum hysterectomy using data from the clinical documentation system. Main outcome measure. Postpartum hysterectomy done during or within 24 hours of birth. Results. The incidence of early postpartum hysterectomy was 1.39/1,000. Abnormally adherent placenta was the most common cause for hysterectomy followed by uterine atony and uterine rupture. There were no maternal deaths. Abnormal placentation, increased blood loss and lower gestational age were significant risk factors in women undergoing hysterectomy. The newborns of these women had a lower birthweight, significantly lower Apgar scores at 1 and 5 minutes and were more often transferred to the neonatal intensive care unit (NICU). An additional analysis in a sample of women with uterine atony identified age as risk factor for hysterectomy. Conclusion. Abnormal placentation, increased blood loss, low gestational age and maternal age are risk factors for early postpartum hysterectomy.