Background:The misoprostol tablet is very soluble and can be dissolved in 20 minutes when it is put under the tongue a pharmacokinetic study compared the absorption kinetics of oral, vaginal and sublingual routes of administration of misoprostol found that sublingual misoprostol has the shortest time to peak concentration, the highest peak concentration and the greatest bioavailability when compared to other routes.The aim of the present study was to to improve the management primary postpartum hemorrhage during and after elective cesarean section (CS). Patients and methods:This study was carried out on 46 cases admitted for elective CS at University Hospital. They divided into two groups regarding the protocol of treatment, was given oxytocin, 10 IU in 250 ml of Normal saline solution over 10 minutes was administered directly after opening the uterus.Misoprostol group was given 400 mcg misoprostol plus intra venous Oxytocin administered directly after opening the uterus. Results: There was statistical significantly between the two studied groups in hemoglobin and HCT postoperatively with higher level among intra venous oxytocin plus intra uterine misoprostol than intra venous oxytocin only group. But regarding preoperative hemoglobin and HCT, there was no statistically significant difference before and after treatment. Higher blood loss either intraoperative, postoperative and overall blood loss on intra venous oxytocin only group than intra venous oxytocin plus intra uterine misoprostol.There was statistical significantly decrease in both hemoglobin and HCT postoperatively in the two studied groups but this decrease was more among intra venous oxytocin only group than intra venous oxytocin plus intra uterine misoprostol. Conclusion:Intrauterine misoprostol combined with oxytocin infusion during caesarean section can minimise intraoperative blood loss, avoid postpartum haemorrhage, and reduce any additional uterotonic medication requirements.