Objective: Aim: To assess the impact of intravenous tranexamic acid (TA) and rectal misoprostol on reducing blood loss during and after cesarean section in low and high-risk groups. Methodology: The study involved 200 pregnant women scheduled for elective cesarean delivery at Beni-Suef University hospital. Participants were randomly divided into two main groups: high-risk and low-risk. Each group was further split into two subgroups: one receiving 400 microgram rectal misoprostol and the other receiving 1 gm (10 ml) (2amp) intravenous tranexamic acid. Post-delivery, all patients received a 10 IU oxytocin (Syntocinon) intravenous bolus. Additional ecbolics (10 IU oxytocin and IM ergometrin) were administered only if blood loss exceeded 500ml or at the surgeon's request. Blood loss was measured post-surgery by weighing pads and monitoring loss during the first 24 hours. Results and Conclusion: Both rectal misoprostol and intravenous tranexamic acid demonstrated comparable effectiveness in reducing blood loss during and after cesarean delivery in both low and high-risk patients for postpartum hemorrhage (PPH). No statistically significant differences were observed among the studied groups regarding the occurrence of postpartum hemorrhage (>1000ml in the first 24 hours) or the neonate's Apgar scores at 1 and 5 minutes. Neither misoprostol nor tranexamic acid side effects were reported.