The objective of this review article was to evaluate the current literature on the increasing off-label use of rFVIIa in the management of critical obstetric haemorrhage. Given the lack of high-level evidence, there is a need to review the clinical indications, observed response and adverse events. This review is designed to aid practitioners in deciding when and how to administer rFVIIa; since the current evidence from observational studies shows that benefits outweigh risks in its use as an adjunct to conventional treatment in massive haemorrhage. However, pregnancy is a potentially thrombogenic state, hence a cautious approach is required in patients with risk factors for thromboembolic complications.