Background: Caesarean section may be life-saving for the mother/baby pair. In spite of the safety of carrying out a caesarean section it is not without some complications. One common complication is theincreased risk of bleeding which occasionally may be life -threatening. Until recently, uterotonics especially oxytocin have been the drug of choice used to reduce blood loss. Misoprostol, an uterotonic agent, has recently been investigated as a potentially useful drug for both prevention and treatment of excessive blood loss at caesarean section. Objective: To evaluate the efficacy of preoperative adjunctive sublingual misoprostol at reducing blood loss at caesarean section. Method: This was a double blinded randomised controlled trial on the efficacy of 200μg preoperative sublingual misoprostol at reducing blood loss in high risk women undergoing caesarean section at the Federal Teaching Hospital Abakaliki (FETHA). Data analysis was done using statistical Package for Social Science (IBM SPSS) software (version 20, Chicago II, USA). Continuous variables werepresented as mean and standard deviation (Mean ± 2SD), while categorical variables were presented as numbers and percentages. Comparison was made using z test and Chi square or Fisher’s exact test for continuous and discrete variables respectively. A difference with a P value <0.05 was considered statistically significant.