To compare the effectiveness and safety of carbetocin, misoprostol and syntocinon in reducing the amount of blood loss following cesarean deliveries.  Patients and Methods: This randomized study was carried out on 180 attended for delivery. A double-blind randomized controlled trial enrolled patients with a singleton pregnancy scheduled for an elective cesarean delivery. The primary outcome was the amount of blood loss. The secondary outcome was the occurrence of uterine atony necessitating additional uterotonics. Per-protocol analyses were performed. Patients, investigators and data analysts were masked to treatment assignments.  Results: It was found that the carbetocin group showed a significant decrease in blood loss intra and post-operative. Also, the decrease in both Hb and Hct level was significantly lower than the other two drugs. On the other hand, the complication and side effect of carbetocin were significantly lower than the other two drugs.
Conclusion: Additional uterotonics were needed less frequently by patients treated with carbetocin. Carbetocin was superior to syntocinon and misoprostol in reducing the blood loss and preventing uterine atony following an elective cesarean delivery.