Background: Caesarean section delivery is associated with severe maternal morbidity, including obstetric haemorrhage, hysterectomy, anaemia, blood transfusion, and infection. Among these operative morbidities associated with CS, obstetric haemorrhage is the leading cause of maternal mortality worldwide. Objective: The aim of this work was to achieve the minimal blood loss during elective cesarean section (CS) in order to decrease patients' morbidity by using tranexamic acid (TXA) injection before operation time. Patients and Methods: The current study was randomized-controlled clinical trial that was conducted at Department of Obstetrics and Gynecology, Zagazig University Hospitals through the period from April 2021 to September 2022. Results: The mean of blood loss during CS in tranexamic acid intervention group was 484.87 cc and mean of blood loss during CS in control group was 705 cc. The difference was highly statistically significant p=0.0001. Per cent of blood loss was 37% more among control group. Conclusions. Tranexamic acid is a good option to reduce the amount of blood loss during CS on high risk pregnancy.