BACKGROUND Caesarean delivery is the most commonly performed surgical interventions in pregnant women worldwide. Excessive post-operative bleeding remained one of its feared complications, despite the application of various strategies. Several studies have demonstrated the efficacy of misoprostol in reducing blood loss during caesarean delivery. Although traditionally used postoperatively the optimal timing of administration of misoprostol with respect to caesarean delivery is still uncertain. AIM AND OBJECTIVES To compare the effectiveness of rectally administered misoprostol given pre-operatively versus those given post-operatively in minimizing blood loss during and 24 hours after caesarean delivery. METHODOLOGY This study was a two – centre randomized controlled trial that was conducted in two tertiary hospitals in Delta state. One hundred consenting patients undergoing caesarean delivery were randomized equally to either preoperative or postoperative group. Primary outcome measure was blood loss during and 24 hours after caesarean delivery; secondary outcome measures were changes in haemoglobin concentration, need for additional uterotonics, need for blood transfusion, need for further surgical intervention and maternal and fetal adverse effect.