ABSTRACT BACKGROUND: Postpartum haemorrhage is a major contributor to maternal mortality despite the use of oxytocin in the management of 3rd stage of labour. The addition of misoprostol may help in further reducing the scourge of postpartum haemorrhage. AIM: To compare the efficacy of oxytocin only versus oxytocin with 400µg of sublingual misoprostol in preventing primary postpartum haemorrhage. METHODOLGY: This was a randomised controlled study involving 252 parturient that had normal vaginal delivery in Federal Teaching Hospital Abakaliki. They were randomly grouped into two groups of 126 participants each. Group A received Oxytocin with 400µg of sublingual misoprostol within one minute of having vaginal delivery of the baby but before delivery of the placenta and group B received Oxytocin and placebo within one minute of having vaginal delivery of the baby but before delivery of the placenta. Blood loss was assessed using BRASS V, predelivery and post-delivery weighed pad and the difference in pre-delivery and postdelivery haemoglobin level. DATA ANALYSIS: The data obtained were tabulated and analysed using the IBM statistical package for the social sciences, version 20 (Chicago ll, USA). Mean and standard deviation (SD) were calculated for numerical variables. Categorical variables were presented as numbers and percentages. Chi-square test was used for qualitative variables while t-test was used for quantitative variables and relative risk (RR) was calculated. A difference with p < 0.05 was considered significant.