Background: Postpartum hemorrhage (PPH) is a significant problem and a major cause of maternal mortality and morbidity, resulting in up to 28% of maternal deaths. It is a potentially life-threatening complication of both vaginal and cesarean delivery, the prevalence of PPH is approximately 6% of all deliveries. Objective: The aim of this study is to compare the effectiveness and safety of carbetocin and misoprostol for the prevention of atonic postpartum hemorrhage in high risk patients. Patients and Methods: this study is a prospective clinical study which was conducted at the Department of Obstetrics and Gynecology, Aswan University Hospital, in the period from September 2017 till September 2018. One hundred cases were involved in the study and divided into 2 equal groups. The study was approved by the medical ethics committee of Aswan University Hospital and a written informed consent is obtained from all patients. Results: Significant difference was found between the two studied groups as regard mean volume of blood loss. Carbetocin group showed the lowest volume of blood loss. As regard uterine tone after treatment, carbetocin group showed the highest tone compared to misoprostol groups. Significant difference was found between the two groups as regard need for additional uterotonics. The results demonstrated an increased use of additional oxytocics in the misoprostol group (32% of cases) VS (12% of cases) in carbetocin group. Conclusion: According to the results of this study, it's concluded that carbetocin is more effective in controlling the amount of blood loss during delivery and eventually help in the prevention of postpartum hemorrhage in high risk patients.