| INTRODUC TI ONRecent years have shown increasing interest in the use of thromboelastography (TEG) (Haemonetics, Braintree, MA) and thromboelastometry (ROTEM; Munich, Germany). These are established point-of-care global viscoelastic hemostatic techniques with several advantages. They use whole blood samples, which are more physiological compared with conventional plasma-based tests, require small volumes, and provide comprehensive and real-time data on coagulation/fibrinolysis. Many successful applications have been reported, including hepatobiliary/cardiovascular surgeries, transfusion therapy, and trauma; however, the routine use of these tests remains surprisingly low in relation to pregnancy and puerperium. 7 Systemic reviews of literature and meta-analyses 1,2 have not shown the routine use of viscoelastic point-of-care tests to improve important clinical outcomes except in cardiac surgery; this was validated by The UK National Institute for Health and Care Excellence (https ://www.nice.org.uk/guida nce/dg13). Although the TEG and ROTEM assays and the technology itself have been analytically validated 3 it is perhaps the clinical validation, applications, and recommendations in relation to pregnancy that still require perfection as future large studies are now available. The effectiveness of TEG and ROTEM as point-of-care tests, in reducing and guiding transfusion therapy is most studied in trauma and postpartum hemorrhage (PPH). 4-6 Other pregnancy-related bleeding or thrombotic disorders are much less studied.Literature shows limited uptake among clinicians regarding the use of TEG/ROTEM during pregnancy, 7-9 which is likely from a perceived lack of evidence. Indeed, there are currently no clinical guidelines on indications of these assays and the strength of available evidence regarding clinical correlates or efficacy remains unknown, with several contradictory opinions reported. A major barrier to improving the application of this technology in obstetrics remains the lack of studies that improve patient outcomes, and an international consensus (at least in key obstetric conditions beyond PPH is lacking).The aim of this project was to systematically review current evidence for the use of TEG/ROTEM in pregnancy and pregnancy-related complications and examine the existing scope of utilization in this context. We would like to clarify that this incorporates not only the use of these tests in assessing PPH and bleeding conditions, but also hypercoagulability and thrombosis risk. For basics about the assay and technology, refer to our previous publications. 10,11 | S E ARCH ME THODS FOR LITER ATURE RE VIE WA systematic 10-year critical literature review was performed by searching OVID versions of MEDLINE and EMBASE for all records between 2007 and 2017. Inclusion criteria were human studies published in English, presented as full manuscripts, with TEG/ROTEM