Introduction & Objective: Although blood transfusion is life saving for obstetric and gynecologic patients, it is responsible for a series of adverse reactions if transfusion not done rationally. Acute transfusion reaction is the commonest one and it can increase the morbidity and mortality. The aim of this study was to evaluate acute transfusion reaction and their associated factors in women who had blood transfusion in the obstetric and gynecologic center of Rasht. Materials & Methods: This was a retrospective descriptive study conducted among 1702 women who underwent blood transfusion at the Al-Zahra teaching hospital in Rasht, during the 5 years period from March 2009. The parameters observed were age, parity index, blood group, underlying disease (anemia, bleeding disorders, hypertension, hypo and hyperthyroidism, diabetes, malignancy, cardiac disease, renal failure and liver disease) and acute transfusion reactions. Statistical analysis was done using SPSS version 19 and Data analyzed with chi-square and Mann-Whitney U test. Results: A total of 60 (3.5%) acute transfusion reactions were reported and the commonest ones were chills (50.0%) and urticaria (26.6%). Acute transfusion reactions were more in patients with anemia (P = 0.006) and bleeding disorders (P = 0.009). Conclusions: Blood transfusion and accordingly its acute reactions may be decrease in gynecologic and obstetric patients with correction or control of anemia and bleeding disorders prior to surgery or delivery. It seems necessary to monitor carefully these reactions and the associated factors to carry out preventive measures.