The use of tranexamic acid to reduce blood loss during and after cesarean section

INTERVENTION: Tranexamic acid (1gm)will be given slowly intravenously over 10 minutes before elective cesarean section CONDITION: Prevention of Postpartum hemorrhage PRIMARY OUTCOME: Mean blood loss (ml) . The quantity of blood loss (mL) during C.S will be measure as follow= (weight of the used surgical towels minus weight of the towels prior to the surgery) + the volume sucked in the suction bottle after placental delivery in mL. ; Blood loss during transfer of the patient to the postoperative care will be measured by using calibrated plastic drape put under the patients intraoperative. ; In addition blood loss after the operation will be calculated separately (within 2Hour postpartum) by using a calibrated plastic drape put under the patients, So the patients can use one or two calibrated plastic drape. SECONDARY OUTCOME: 1‐Blood loss 500 ml or more ( blood loss will be measured for two hours after operation using a caliberated plastic drape put under the patient). 2‐Blood loss 1000 ml or more (blood loss will be measured using a calibrated plastic drape put under the patient for two hours after operation). 3‐use of additional medical intervention to control postpartum hemorrhage. The files of patients will be checked for additional medications to control PPH , for example oxytocin, methyl ergometrin, prostaglandins. 4‐ Use of additional surgical intervention to control PPH. The files of the patients will be checked for added surgical interventions , like compresssion sutures, ligation of uterine artery , ligation of hypogastric artery, hysterectomy. 5‐Mild side effects such as (nausea, vomiting, headache, skin reaction). The files will be checked for any reported side effects or medications given to treat these side effects. For example antiemetics. 6‐Serious adverse events as:Thromboembolic event. This willl be diagnosed clinically or using Doppler ultrasound. INCLUSION CRITERIA: All pregnant women with single fetus planned to have elective cesarean section at greater than 36wks gestation