Inclusion Criteria:  Pregnant female single tone >38 weeks Age :18-45 years old. patient with ASA III Cardiac patients ( mild and moderate mitral stenosis-aortic stenosis valve disease )  Exclusion Criteria:  Other cardiac conditions (valve regurge, cardiomyopathy, heart failure,severe mitral stenosis, severe aortic stenosis, severe pulmonary hypertension) Pregnancy hypertensive disorders (eclampsia,preeclampsia) Abnormal placental attachment (accrete,percreta,increta) Patients with bleeding disorders patient with high risk of postpartum haemorrhage