Objective: was to compare the role of methergine, misoprostol and calcium in the management of atonic postpartum hemorrhage. Design: Randomized Controlled Trial. Setting: This study was conducted in obstetrics and gynecology department of Al-azhar University Hospital, Assiut. Patients: 300 women with PPH were included in the study. Intervention: 300 women, each received 5 IU of oxytocin as prophylaxis then divided into three groups: Group A (N=100): women with atonic PPH took methergine, Group B (N=100): women with atonic PPH took misoprostol and Group C (N=100): women with atonic PPH took calcium. Outcome measures: The primary outcome was change in hemoglobin concentration before and after intervention. Results: There was no significant difference between the three study groups as regard mean hemoglobin level before and after treatment. However, a significant difference was present as regard mean change (drop) in hemoglobin level after treatment, with misoprostol group showing the highest drop in Hb% (2.07 ±0.8) compared to calcium group (1.7 ±0.8) and methergine group (1.3 ±0.5).  Conclusion: Methergine is more effective in controlling the amount of blood loss during delivery giving a better chance in treatment of atonic postpartum hemorrhage followed with calcium then misoprostol. Although of that calcium is good alternative to methergine with low side effects so can be used safely and effectively when methergine is contriandicated.