Introduction: Pre-operative anaesthetic assessment plays a crucial role in managing high-risk obstetric cases. This study aimed to evaluate the effectiveness of comprehensive pre-operative anaesthetic assessment in reducing maternal morbidity in high-risk obstetric patients at a tertiary care center. Methods: A prospective cohort study was conducted over 12 months, involving 220 high-risk obstetric patients scheduled for elective caesarean section or other obstetric surgeries. Participants were divided into an intervention group receiving comprehensive pre-operative anaesthetic assessment and a control group receiving standard care. Primary outcomes included composite maternal morbidity, perioperative outcomes, and patient satisfaction. Results: The intervention group demonstrated significantly lower composite maternal morbidity compared to the control group (10.9% vs. 20.9%, OR 0.46, 95% CI 0.22-0.98, p=0.042). Perioperative outcomes showed improvements in the intervention group, including reduced estimated blood loss (median 450 mL vs. 500 mL, p=0.032), shorter time to ambulation (14.2 vs. 16.8 hours, p=0.001), and decreased length of hospital stay (median 3 vs. 4 days, p=0.003). Patient satisfaction scores in the intervention group were high, with a mean overall satisfaction score of 8.7 out of 10. Conclusion: Comprehensive pre-operative anaesthetic assessment significantly reduces maternal morbidity and improves perioperative outcomes in high-risk obstetric cases. The observed benefits in clinical outcomes, patient satisfaction, and potential cost-effectiveness support the implementation of structured pre-operative assessment protocols in tertiary care settings for high-risk obstetric patients.