Viscoelastic testing shows promise in reducing postpartum hemorrhage deaths

Viscoelastic testing shows promise in reducing postpartum hemorrhage deaths | Image Credit: © kittyfly - © kittyfly - stock.adobe.com.

In a recent review published in the International Journal of Obstetric Anesthesia, viscoelastic testing (VET) was indicated as a potential driver of reducing postpartum hemorrhage mortalities.¹

The blood-monitoring technology is minimally invasive and can identify the progress of blood clotting, alongside informing clinicians about the most effective type of blood transfusion for stopping hemorrhage. Alongside reducing the risk of mortality, VET has been highlighted as a method to save costs over time and reduce health disparities.¹

“Maternal mortality is a serious public health challenge, including in the US, which is especially troubling because the majority of cases are preventable,” said Susanne Hempel, PhD, professor at the Keck School of Medicine. “The problem is that severe postpartum hemorrhage is a rare event, so hospitals are not always prepared for it.”¹

Limited research but promising potential

The review was conducted to assess VET use for postpartum hemorrhage.² Investigators conducted literature searches of 14 databases in July 2025, identifying 156 publications. Of these, 106 were research studies.

Alongside evaluating the studies, investigators interviewed patients, providers, policymakers, and researchers.¹ During these discussions, interviewees were asked about why the United States has not yet adopted VET technology, alongside changes that may improve the pace of rollout.

Only 2 of the studies were randomized controlled trials. According to Hempel, this limitation is caused by the rarity of postpartum hemorrhage, requiring massive sample sizes with researchers working for many years or within a large system. Currently, investigators have concluded that research about VET in maternity care is limited.¹

Cost savings and long-term benefits

However, the current data available has indicated promise for VET in this setting. While not approved for use in childbirth, the technology has received FDA approval for use in blood transfusions during cardiac surgery, orthopedic surgery, and trauma.¹

Barriers toward VET adoption were also reported and included the cost of setting up systems, training clinicians to use them, and integrating them into hospitals. Investigators also highlighted a lack of scientific consensus on best practices as a major barrier to VET use.¹

Over time, the cost of VET will be reduced compared to other technology, as it is capable of identifying necessary blood components for transfusion. This can help clinicians identify when expensive whole blood products are unneeded, saving them for critical situations.¹

Based on these results, study authors recommended further research to analyze the impact of VET protocols on maternal morbidity.² These protocols may be effective for decreasing transfusion volume, postoperative bleeding, and overtreatment.

Potential to address health disparities

Additional data can be obtained through a large, multicenter randomized controlled trial.¹ This information can be used to develop a consensus for best practices and outline specialized approaches needed for conditions such as preeclampsia.

Hempel highlighted the increasing evidence supporting widespread adoption of VET in the United States. This includes the benefits of timely access to care provided, which can save the lives of Black women and women living in rural areas who are more likely to die during childbirth.¹

“Sometimes, the potential of a technology makes it worth using while the evidence continues to roll in,” said Hempel. “People use parachutes not because they are convinced by the evidence from randomized controlled trials, but because they’re convinced by the logic of it.”¹

References

1. Major review highlights latest evidence on real-time test for blood – clotting in childbirth emergencies. Keck School of Medicine of USC. September 18, 2025. Accessed September 26, 2025. https://www.eurekalert.org/news-releases/1098897.
2. Janzen C, Zhang D, Herman S, et al. Viscoelastic testing in postpartum obstetric hemorrhage: a scoping review commissioned by the Patient-Centered Outcomes Research Institute (PCORI). International Journal of Obstetric Anesthesia. 2025;64. doi:10.1016/j.ijoa.2025.104763