Peripartum hysterectomy can be defined as a hysterectomy performed at the time, or within 24 hours, of delivery. Another definition is a hysterectomy performed any time from delivery to discharge from the same hospitalization. This topic will review the surgical planning, key operative points, and postoperative care for peripartum hysterectomy. Related topics can be found separately and include: (See "Abdominal hysterectomy) (See "Overview of preoperative evaluation and preparation for gynecologic surgery. EPIDEMIOLOGY AND RISK FACTORS Based on population level data, the peripartum hysterectomy rate is nearly 1 per 1000 deliveries (eg, 0.1 percent) in the United States U. In addition to abnormal placentation, other significant risk factors for peripartum hysterectomy include advanced maternal age and parity, multiple gestations, antepartum bleeding. preeclampsia, bleeding disorders, and the use of assisted reproductive technologies (2-7). Secondary analysis of a large, multicenter postpartum hemorrhage trial reported that abnormal placentation was the most common cause of hysterectomy and that advanced maternal age and delivery by cesarean section were significant risk factors [8). While the majority of patients with these risk factors will experience neither major hemorrhage or hysteres husterectomy patients who have multiple risk factors or a history of prior postpartum her e whould deliver in a setting where hysterectomy is readily available if needed.