Background: Caesarean section is a lifesaving surgery that has contributed to the reduction in maternal morbidity and mortality when appropriately applied. Average blood loss during caesarean section is twice the blood loss during vaginal delivery. In addition, caesarean section is associated with higher risk of uterine atony, therefore, increasing the risk for postpartum haemorrhage. To reduce the blood loss during caesarean section, obstetric units use oxytocin suring the surgery to prevent uterine atony and reduce blood loss. Despite this, some patients require additional uterotonics and or anti-fibrinolytic agents to prevent excessive blood loss. Postpartum haemorrhage is difficult to predict as it can occur in patients with no risk factors. Tus, it is therefore important to prevent blood loss during caesarean section effectively. Objectives: To evaluate the effect of preoperative administration of sublingual misoprostol and intravenous tranexamic acid on intra-operative blood loss during elective caesarean section. Methodology: The study was a double blinded randomized control study which involved 116 women scheduled for elective caesarean section and consented for the study in the obstetrics and gynaecology department of University of Calabar Teaching Hospital. The participants were divided into two groups. Group 1 (n=58) received 1000mg of intravenous tranexamic acid over 10 minutes about 10-15 minutes before skin incision and 600 micrograms of sublingual misoprostol after spinal anaesthesia and before skin incision. Group 2 (n=58) received placebos. Both groups had oxytocin infusion after clamping of the umbilical cord at caesarean section. The primary outcome of the study was the estimation of intra-operative blood loss and the difference between preoperative and postoperative hematocrit values in both groups. Independent t test was used to compare mean of scale variable and the Chi-square test was used to compare statistical significance of categorical variable. Multiple linear regression was used to evaluate the effect of duration of operation and incision delivery interval on intraoperative blood loss. The P values of less than 0.05 was considered significant.