INTRODUCTION: Blood loss during caesarean section (C/S) may lead to postpartum haemorrhage, which is one of the direct causes of maternal morbidity and mortality globally. In this centre, intravenous tranexamic acid is not used prophylactically to reduce blood loss during and after caesarean section probably due to lack of evidence-based study and experience with the medication. AIM: To assess the effect of prophylactic intravenous tranexamic acid on blood loss during and after elective C/S at the University of Port Harcourt Teaching Hospital (UPTH). METHODS: This was a prospective, single-blind, randomized, placebo-controlled interventional study conducted at the Obstetric theatre of UPTH from July 2020 to March 2021. Eligible women were randomized into two groups; Seventy-two women received intravenous tranexamic acid while seventy-one women received a placebo. Socio-demographic data and the result of the study were collected through a research proforma. Data collected was analyzed using Statistical Package for Social Sciences (SPSS) Version 22.0. The results were expressed in tables and charts that displayed frequencies, percentages and mean of the data. Chi-square test, fisher’s exact, and t-test were used to determine the relationship between variables. P-value ≤ 0.05 was considered statistically significant.