Introduction: Postpartum haemorrhage (PPH) during the third stage of labour is the most common cause of maternal deaths in developing countries. Active pharmacological management of this stage to prevent haemorrhage with an uterotonic drugs leads to a decrease in postpartum vaginal haemorrhage. The aim of this study was to assess and compare the effectiveness of rectal misoprostol compared with an intravenous oxytocin and intramuscular carboprost in active management of third stage of labour. Material and Methods: A total of 400 women in labour were randomized into four groups (100 women in each). Within 1 minute of delivery of the anterior shoulder participants in group A received 800mg of rectal misoprostol; group B received 0.2mg of methylergometrine intravenously; group C received 125mg of carboprost intramuscularly and group D served as control and had not received any prophylactic uterotonics. Results: All groups were compared regarding the need for excessive uterotonics, amount of blood loss, and hematocrit drop. Per rectal misoprostol was found to be equal or better to rest of the drugs in the study with lowest duration of third stage of labor (mean =8.69 mins), lowest amount of blood loss (mean=149.90 ml), haematocrit drop (0.51±0.32) and lowest incidence of PPH. There was no significant difference in the duration of third stage of labor amongst the four groups. Conclusions: Per rectal Misoprostol is equal or better as compared to injection methyl ergometrine or carboprost and can prove to be better alternative because of several advantages.