Background Primary postpartum haemorrhage (PPPH) is one of the common causes of maternal morbidity and mortality. Uterine atony is a major cause of postpartum haemorrhage. Postpartum haemorrhage can be prevented by avoiding the associated risk factors and ensuring active management of third stage of labour. With the introduction of active management of third stage of labour, there has been a significant reduction in primary postpartum haemorrhage. However, much needs to be done to eliminate PPH as the incidence is still unacceptably high. Aim of the study The study seeks to determine the efficacy of administering prophylactic 600 microgram rectal misoprostol immediately after the delivery of placenta in reducing postpartum blood loss. Methods This was a randomised controlled single blind study in which eligible consenting parturients were randomized into two groups. In addition to other measures of active management of third stage of labour, the study group received 600 micrograms of rectal misoprostol immediately after delivering the placenta. The primary outcomes measured were estimated blood loss and haemoglobin change from the intrapartum value. The secondary outcomes were misoprostol side effects and need for blood transfusion.