Background: Primary post-partum hemorrhage (PPH) is defined as blood loss greater than or equal to 500 ml within 24 hours after birth, while severe PPH is blood loss greater than or equal to 1000 ml within 24 hours. Objective: was to determine the efficacy and safety of tranexamic acid in reduction of blood loss after the elective cesarean sections. Patients and Methods: We performed a randomized, controlled study of 200 pregnant females who underwent elective CS. The patients had attended the Labor Ward in Al-Azhar University Maternity Hospital. 100 of them received tranexamic acid 20 minutes before beginning of anesthesia in addition to oxytocin after delivery of the baby; the other 100 patients received oxytocin only. Results: In the 1st two hours post-partum vaginal bleeding was significantly less severe in study group than control group (p<0.019). There was nonsignificant difference between study and control groups as regards preoperative hemoglobin concentration (p=0.195), Postoperative hemoglobin concentration was significantly greater in study group than control group (p<0.001), Reduction in hemoglobin levels ware significantly less in study group than control group (p<0.001). There was nonsignificant difference between study and control groups as regards to preoperative hematocrite (p=0.967), Postoperative hematocrite levels were significantly higher in study group than control group (p0.015), Reduction in hematocrite levels ware significantly less in study group than control group (p<0.001).