Blood transfusion is one of the key interventions in emergency obstetrics care and is known to save lives, however complications do occur. Pregnancy has certain peculiarities, which includes physiological changes, development of antigens against red cells, leucocytes and platelets. History of previous transfusion is common in pregnancy. The aim of this study is to find the incidence, presentations, types and risk factors for developing acute transfusions reaction in pregnancy. Materials and methods: Retrospective study of all blood transfusions in pregnancy between January to December 2012 at Federal Medical Centre Azare, Nigeria. Results: 1602 pregnant women received blood transfusion out of 15213, given a transfusion rate of 10.5% the mean age and parity were 28.3 ± 4.2 years and 6 ± 1 respectively. Acute reactions were found in 26.3%. Non heamolytic febrile reaction accounts for 47.7%. Allergic uticaria account for 24.5%. There was a significant relationship between stored blood and transfusion reactions, similarly, significant relationship was found between previous history of transfusion and transfusion reactions, but no difference was found between rise and full cross match and uncross match but ABO compatible blood in developing transfusion reactions. Conclusions: As blood transfusion alternatives are not readily available or not practical in pregnancy hemovigilance is the key to making blood transfusion safer.