Objective To investigate the predictive value of prenatal tissue inhibitor of matrix metalloproteinase 1 (TIMP-1), transforming growth factor-β₁ (TGF-β₁), and thromboelastography (TEG) for postpartum hemorrhage in hypertensive pregnancies.Methods A total of 211 hypertensive pregnant women (May 2023-October 2024) were stratified by severity: preeclampsia group (n = 124, age 23 - 33 years, mean 28.94 ± 7.86) and severe preeclampsia group (n = 87, age 26 - 31 years, mean 29.17 ± 7.43). Venous blood was collected pre-delivery for TEG, TIMP-1, and TGF-β₁ measurements. Postpartum hemorrhage rates were recorded. Multivariate logistic regression analyzed hemorrhage risk factors. Receiver operating characteristic (ROC) curves evaluated predictive performance.Results The severe preeclampsia group exhibited higher coagulation time (K) but lower maximum amplitude (MA) and coagulation index (CI) versus preeclampsia group (P < 0.05). Reaction time (R) and α-angle showed no intergroup difference (P > 0.05). Hemorrhage rates were 25.29% (22/87) in severe preeclampsia versus 9.68% (12/124) in preeclampsia (P < 0.05). Elevated TIMP-1 [O^R = 1.003 (95% CI: 1.000, 1.005) ], increased K [O^R = 1.079 (95% CI: 1.001, 1.163) ], reduced TGF-β₁ [O^R = 0.994 (95% CI: 0.989, 1.000) ], decreased MA [O^R = 0.977 (95% CI: 0.967, 0.988) ], and lower CI [O^R = 0.731 (95% CI: 0.587, 0.910) ] were independent risk factors (P < 0.05). Combined detection yielded sensitivity = 61.8% (95% CI: 0.436, 0.778) and specificity = 83.1% (95% CI: 0.767, 0.883).Conclusion Combined assessment of serum TIMP-1, TGF-β₁, and TEG effectively predicts postpartum hemorrhage risk in hypertensive pregnancies.