Background: The major cause of morbidity and mortality following caesarean delivery is haemorrhagedue to uterine atony. Oxytocin is needed to prevent excessive blood loss. However, additional uterotonics are occasionally needed to achieve this purpose. Evidence is scanty in our environment on theeffect of combiningpre-incision rectal misoprostol withparenteral oxytocin on blood loss at caesarean delivery. Aim: To assess the effect of pre-incision rectal misoprostol on blood loss at caesarean delivery. Methodology: This isa prospective controlled study, in which 100parturient at term undergoing emergency or elective caesarean delivery for various indications were recruited. The participants were randomized to either parenteral oxytocininfusion after delivery of the baby combined with 600µg of wet rectal misoprostol passed after securing spinalanaesthesia or parenteral oxytocin infusion only after delivery of the baby. The primary outcome measure was the mean intraoperative blood loss and secondary outcome measures include drop in mean haematocrit concentration, proportion of participants who required extra measures and those who developed side effects and fetal outcomes. Student t-test was used to comparecontinuous variables among the intervention arm and the control while Chi square or Fischer exact test for categorical variables as appropriate. Wilcoxon Signed Ranks Test was used to analyse the Non-parametric data. The level of significance α is set at 0.05.