Background: In the management of parturients with risk factors for uterine atony, it is generally considered good practice to administer an adjunctive uterotonic agent after routine active management of the third stage of labour. Objective: Adjunctive rectal misoprostol was compared with oxytocin infusion after routine active management of the third stage of labour in parturients with risk factors for PPH, to determine its effectiveness in reducing intrapartum blood loss and postpartum haematocrit drop, as well as need for additional uterotonics or surgical intervention. Method: 255 parturients with risk factors for PPH were randomized to receive either rectal misoprostol (600μg; n=126) or oxytocin infusion (20IU in 500mL; n=129) after routine active management of the third stage of labour. Intrapartum blood loss was measured using a combination of the BRASSS-V calibrated drapes and differential pad weighing. Haematocrit was measured intrapartum and 24hrs postpartum.