**6.1 Position**

Hysterectomy should be performed in the low lithotomy position. This position offers several advantages: (a) It allows for a thorough examination of patients with postpartum hemorrhage. It is an ideal position for identifying the source of bleeding. Lower genital tract lacerations and atonic bleeding are more easily recognized in this position. Additionally, transvaginal ultrasonography can be comfortably performed, facilitating the identification of upper intraperitoneal or extraperitoneal hematomas. (b) In cases of active bleeding, until the abdominal incision is initiated, this position enables the application of bimanual or vaginal tampons. (c) It is suitable for surgical interventions via the vaginal route. For cervical tears, cervical suturing can be performed, and in cases of deep vaginal tears, access to the pararectal or paravesical spaces can be achieved vaginally for necessary interventions and suturing. (d) This position provides advantages for surgical interventions via the abdominal route. Avascular spaces can be more easily accessed, allowing for better visualization of the topographic anatomy. This not only facilitates easier interventions but also reduces the risk of complications. Specifically, in cases with significant volume deficit requiring arterial ligation or placental invasion anomalies, this position is more advantageous for reducing bleeding and preventing complications. Furthermore, in placental invasion anomalies, the low lithotomy position is more beneficial during bladder dissection than the normal position.
