While Carbetocin is effective in reducing PPH, the combination of oxytocin, Tranexamic acid, and Ergot derivatives may offer additional benefits in high-risk populations. We hypothesize that the combination regimen will reduce PPH incidence and severity compared to Carbetocin alone and may be more cost effective

Inclusion Criteria:

• Women undergoing C-Sections.
• Women between the ages of 18 and 45 years.
• Singleton pregnancy.
• Gestational age is equal to or more than 36 weeks.
• No known coagulopathy or bleeding disorders.
• No known hypersensitivity or allergy to drugs used in the study.
• Normal obstetric ultrasonography with no fetal abnormalities.

Exclusion Criteria:

• Hemodynamically unstable or immobile patients.
• Multifetal pregnancy.
• Patients who are receiving prophylactic or therapeutic anticoagulation.
• Known comorbidities and contraindications to the use of Ergot derivatives or Carbetocin such as hypertension or cardiovascular disorders.
• Placenta previa and/or Placenta accreta spectrum.
• History of thromboembolism.
• Preeclampsia or eclampsia.
• Any additional measurements needed to control or stop excessive bleeding intraoperatively such as uterine artery ligation or use of sterile gelatin absorbable foam.