Background: Obstetric haemorrhage is the commonest direct cause of maternal morbidities and mortality worldwide, most of which is due to post-partum haemorrhage (PPH). Women undergoing caesarean section are at increased risk of blood loss. Considering the rising rate of caesarean section (CS) worldwide and corresponding increase in blood loss; modalities that will help reduce blood loss should be welcomed. Misoprostol has been used in this regard but excessive blood loss still occurs. Recently, tranexamic acid has also been suggested but it has not been routinely used to control blood loss during CS. We do not if misoprostol if better than tranexamic acid in this regard. There is urgent need to compare the efficacy of misoprostol and tranexamic acid in reducing blood loss during caesarean section Aim: The efficacy of tranexamic acid was compared with misoprostol in reducing blood loss during elective CS at FETHA. Objectives: compared the need for blood transfusion, use of additional uterotonics, to control blood loss, net change in packed cell volume, difference in pre and post-operative blood pressure and pulse rate. Methodology: it was an open randomized controlled trial involving one hundred and fifty consented pregnant women that underwent elective caesarean section at FETHA. The women were randomized into two arms, (75) per groups; group A; the misoprostol group received 1000µg of rectal misoprostol after spinal anaesthesia, Group B; tranexamic acid group received 1g of intravenous tranexamic acid after spinal anaesthesia. The quantity of blood loss was compared post-operatively by measuring the weight gain in the abdominal mops used during the caesarean section and mean change in Packed Cell Volume (PCV) post-operatively.