**7.3 Who bleeds more?**

Limited studies have been conducted to predict which cases are more prone to increased bleeding during peripartum hysterectomies. The data obtained from these studies are generally retrospectively designed due to ethical reasons and has limited evidence levels. However, it is known that the most effective factors contributing to increased bleeding are the necessity of performing hysterectomy in emergency conditions, limitations in preoperative preparations, and multidisciplinary approach.

As a notable finding, it has been observed that patients who have not previously undergone cesarean delivery surprisingly experience more bleeding during surgery. Additionally, other factors that contribute to increased bleeding include the absence of intra-arterial balloon usage, the presence of known coagulation disorders in the patient, and awareness of the patient's desire to maintain fertility [25, 26].

For effective control of bleeding during peripartum hysterectomies, early diagnosis, appropriate interventions, and a multidisciplinary approach involving obstetricians, anesthesia specialists, and hematologists are important. However, further research and comprehensive studies are needed to better understand the risk factors for bleeding in peripartum hysterectomies and to develop management strategies.
