Aim: To assess the utilization of blood and appropriateness of blood transfusion using utilization indices in the gynecology and obstetrics department of a tertiary care center. Materials and methods: A retrospective observational study was carried out in Gynae unit 3 of Abbasi Shaheed Hospital from July 1, 2016, to December 31, 2016. For this study, case records of all women who had an elective or emergency procedure were compiled and reviewed. The blood utilization indices, cross-matched to the transfusion ratio (C/T ratio = number of units cross-matched/number of units transfused), transfusion probability (%T = number of patients transfused/number of patients cross-matched × 100), and transfusion index (TI = number of units transfused/number of patients cross-matched) were calculated for all. Results: A total of 598 patients underwent major elective and emergency surgical procedures in the department. These patients were requested to prepare 1,074 units of blood. From a total of 1,074 units cross-matched, 374 were transfused. Thus, only 34.8% of the cross-matched blood was utilized. Of the 598 patients for whom blood was cross-matched, only 279 (46.65%) patients were transfused. The overall blood transfusion indices of the requested blood, C/T ratio, %T, and TI, were 2.87, 46%, and 0.62. Conclusion: Our study showed underutilization of blood in terms of cross-matched to the transfusion ratio but the probability of transfusion and the transfusion index were appropriate. Clinical significance: Blood ordering practices need to be reviewed periodically in all units.