Background: Postpartum haemorrhage (PPH) is a major cause of maternal mortality worldwide. Prevention methods including uterotonic agents are key to improving outcomes. This study compares Rectal Misoprostol and Intramuscular (I/M) Oxytocin in reducing blood loss and haemoglobin (HB) level changes during delivery. Method: This was a randomized study conducted at the Saraswathi Institute of Medical Sciences, Hapur, between August 2022 and July 2024 on 200 women with low-risk term pregnancies. The subjects were allocated to Group A (600 µg rectal misoprostol) or Group B (10 IU I/M oxytocin) There was an estimation of blood loss for 24 hours after delivery, and the measurement of haemoglobin was done pre- and post-delivery, respectively. Statistical data analysis was performed using SPSS v25.0. Results: Mean blood loss was lower in Rectal Misoprostol group (201.0 ± 46.8 ml) compared to I/M Oxytocin group (222.8 ± 42.4 ml, p < 0.001). Mean haemoglobin decline was also smaller in Rectal Misoprostol group (-0.53 ± 0.3 gm/dl) compared to I/M Oxytocin group (-0.76 ± 0.6 gm/dl, p = 0.002). Conclusion: Rectal Misoprostol is better than I/M Oxytocin in reducing blood loss and haemoglobin decline in postpartum women.