American Board of Obstetrics & Gynecology (ABOG) Qualifying Practice Exam

The correct choice identifies abnormal placentation and multiparity as significant risk factors for peripartum hysterectomy. Abnormal placentation, which includes conditions like placenta previa and placental abruption, can lead to severe hemorrhage during delivery, making hysterectomy necessary to control bleeding and save the mother's life. Multiparity also increases the likelihood of complications during childbirth, including uterine atony and surgical complications that could necessitate a hysterectomy.

While other factors listed, such as obesity, diabetes, advanced maternal age, and smoking, can contribute to maternal morbidity during pregnancy, they are generally less directly associated with the need for a peripartum hysterectomy compared to abnormal placentation and multiparity. Each of these conditions can contribute to a higher risk of complications, but it is the presence of abnormal placentation—particularly in women who have had multiple pregnancies—that significantly escalates the risk of needing this surgical intervention during or immediately following delivery.