Objective: To evaluate therapeutic yield of tranexamic acid (TXA) injection and fluid co-load on the outcome of cesarean section (CS) conducted under spinal anesthesia. Study design: prospective randomized comparative study. Patients and methods: The current included 174 primipara scheduled for elective CS under spinal anesthesia. Intravenous (IV) fluid co-load (15 ml/kg warm lactated ringer solution) started as fast drip during and continued after spinal anesthesia. Patients were randomly allocated into two equal groups: Group TXA received a loading IV dose of 500 mg TXA 20 minutes before surgery followed by continuous TXA infusion at rate of 1 mg/kg/min till end of surgery. Group C did not receive prophylactic TXA, but both groups received a booster dose of 2 gm TXA if required. Patients were monitored for the frequency and severity of hypotension and dose of ephedrine used. Amount of bleeding since skin incision till 2-hours postpartum (PP), the frequency of patients had stopped PP bleeding till 2-hr PP and the total dose of oxytocin drugs and booster doses of TXA were recorded. Results: Hypotension was recorded in 53 patients (30.5%); only 12 patients had blood pressure