In obstetrics, the decision to transfuse blood components has historically been driven by traditional laboratory testing in combination with direct observation of bleeding. The adjunctive use of viscoelastic testing, including thromboelastometry and thromboelastography, has gained increasing acceptance in the clinical domain.
We performed a review of the published medical literature by searching the PUBMED database for keywords "viscoelastic" and "obstetric," as well as "viscoelastic" and "postpartum hemorrhage." Additionally, case reports and expert opinion publications that referenced viscoelastic studies in obstetrical patients were evaluated.
There is very little high-quality evidence currently published in the medical literature to support the notion that viscoelastic testing obviates the need for traditional coagulation testing or improves mortality resulting from major obstetrical hemorrhage.
Additional research is needed to further focus the optimum role of viscoelastic tests in major obstetrical hemorrhage.