Background: post partum hemorrhage is an obstetrical emergency that can follow vaginal or cesarean delivery. It is one of the bleeding causes of maternal mortality, especially in the developing countries. A step-wise approach to management of post partum hemorrhage was recommended. Aim of the Work: this study aimed to compare between conservative treatment and using Bakri balloon catheter in cases atonic postpartum hemorrhage. Patients and methods: this prospective randomized study was conducted on 100 patients managed by conservative treatment or by using Bakri balloon catheter with intrauterine washing with misoprostol at the Department of Obstetrics and Gynaecology, Aswan General Hospital in the period from 1 October 2017 to 30 September 2018. Results: the descriptive of risk factor of all the studied cases indicated that anemia was the major risk factor (34 cases, 34%). The causes of PPH showed that uterine atony was the major cause of PPH (71 case which contributed 71% of the total cases) and the second cause was placenta previa (29%) with 29 cases of the total. Bakri ballone catheter with intrauterine wash with misoprostol decreased significantly (p<0.001) the number of patients who need blood transfusion from 50 cases (100%) in group 1which received conservative management only to 44 case (88%) in group 2. Also, using Bakri ballone catheter with intrauterine wash with misoprostol decreased significantly (p<0.001) the amount of blood units needed. Conclusion: postpartum hemorrhage (PPH) remains one of the top five causes of maternal mortality worldwide in both the developed and developing countries. The use of tamponade test in a tonic postpartum hemorrhage has a good predictive value in controlling of bleeding. Our study showed that tamponade with Bakri ballone deserved a place in the treatment of post partum hemorrhage. It is simple, readily available, effective and safe procedure. Bakri ballon tamponad (BBT) does not exclude the use of other procedures if necessary. Even if BBT failed, it may provide temporary tamponad and time to prepare for other intervention or transportation from local hospital to tertiary center