〔Abstract〕 Objective To explore the application of thrombelastogram in monitoring clinical blood transfusion of obstetric massive hemorrhage. Methods From June 2019 to December 2020, 82 patients with obstetric hemorrhage receiving blood transfusion treatment in the Third People's Hospital of Huizhou were selected and divided into control group and observation group according to the simple random number table method, with 41 cases in each group. Routine coagulation test was used to guide blood transfusion in the control group, and thrombelastogram test was used to guide blood transfusion in the observation group. The amount of blood preparation, coagulation status at different time points and clinical outcomes were evaluated. Results The usage of blood preparations such as suspended red blood cells, fresh frozen plasma, cryoprecipitate coagulation factor and platelets in observation group was lower than that in control group, the difference was statistically significant (P < 0.05; There was no significant difference in coagulation status between the two groups at different time points (P > 0.05); The amount of postoperative bleeding in the observation group was significantly lower than that in the control group, the difference was statistically significant (P < 0.05); There was no significant difference in length of stay and mortality between the two groups (P > 0.05). Conclusion Thrombelastogram monitoring of clinical blood transfusion for obstetric massive hemorrhage can effectively slow down postoperative blood loss, reduce the use of blood preparations, and promote the recovery of patients.