Background: neonatal respiratory morbidities are common neonatal outcome the worrisome the mothers the most when approaching labour. They vary in clinical presentations with various long term effects, the most importantly related to caesarean section are Transient Tachypnea of the Newborn (TTN), Respiratory Distress Syndrome (RDS), Persistent Pulmonary Hypertension (PPHN). Aim of the Work: the aim of this study is to assess the efficacy of Misoprostol or the Prostaglandin E1( PGE1) on the reduction of the neonatal respiratory morbidity in women scheduled for term caesarean section (38-38⁺⁶ weeks Gestational Age (GA). Patients and  Methods: this is a Randomized Controlled Trial (RCT) which was conducted over six months from November 2016, to April 2017 on 120 pregnant women who were approached before elective caesarean section (ECS), managed in Ain Shams University Maternity Hospital (ASUMH), and their neonates followed up in the Neonatal Intensive Care Unit (NICU) of Ain Shams University Maternity Hospital to assess the effect of Misoprostol when given for women one hour before their scheduled caesarean section upon reducing the neonatal respiratory morbidity. Results: the current study revealed a highly statistically significant difference between groups according to respiratory morbidity, and especially the TTN using Chi-square test, with p-value <0.001 Highly Significant. Conclusion: the study concluded that when a vaginal tab containing Misoprostol 200 microgram given to women one hour before term elective caesarean section between 38-38⁺⁶ weeks compared to placebo, it simulates the normal labour to enable the neonate through catecholamines surge, and thus surfactant secretion for better adaptation to the extrauterine life. Recommendations: Misoprostol can be administered vaginally to candidate pregnant women with term pregnancies with certain inclusion criteria before an elective caesarean section (after exclusion of any contraindication and thorough good history taking and clinical examination) in order to reduce the neonatal respiratory morbidity and especially the transient tachypnea of newborn. Thus, decrease the duration of neonatal NICU admission and mortality.