Postpartum hemorrhage, is one of the most deadly complication of pregnancy worldwide and
major cause of maternal mortality especially in third world countries .1 PPH affects about 5%
of all women giving birth around the world 2 .Primary PPH is defined as ≥500 mL blood loss
after vaginal delivery or ≥1000 mL after CS delivery within 24 hours after birth1 . Globally,
almost one quarter of all maternal deaths are linked with PPH 2. Due to the high prevalence
of anemia among pregnant women in low-resource settings, the outcome of PPH is often
deteriorated, resulting in damaging health consequences 3. Roughly in 70% of cases of primary
pph are due to uterine atony11. Uterine atony is due to loss of contraction and retraction of
myometrial muscle fibers can lead to severe hemorrhage and shock. There are several reasons
behind uterine atony including maternal anemia, fatigue due to prolong labour and rapid
forceful labour. Blood loss is double in caesarean section due to use of increased anesthetic
agents4. According to WHO use of oxytocin (10 IU, IM /IV) is recommended for prevention of
PPH for all births2. Despite its effectiveness, 10-40% of cases need additional uterotonics
to ensure good uterine contraction.5 After oxytocin , Misoprostol is increasingly known as a
potential treatment option for PPH 5 .Misoprostol is easily available , rapid acting , and
cost effective with minimal side effects, however in caesarean section owing to the effect of
anesthesia limits its use . In recent study conducted at Egypt, oxytocin plus misoprostol
(study group) is compared with oxytocin alone (control group). Incident of pph was
significantly lower in study group (p=0.018), as in study group (1.33%) than control group
(6.67%)8. Misoprostol is an autacoid substance and act better if placed closed to target
organ 9. Several routes of misoprostol, with or without oxytocin, and its result on
intrapartum and postpartum hemorrhage are described in the literature. The practice of
misoprostol by the intrauterine route during caesarean section is under trial.10. Aim of
study is to observe the effectiveness of intrauterine misoprostol in addition to oxytocin to
minimize the blood loss during caesarean section.