Background: Postpartum hemorrhage and hypertensive disorders are the greatest contributors to maternal death in developing countries accounting for more than 50% of direct causes. Objective: This study aimed to improve the clinical outcomes of carbetocin versus oxytocin in preventing postpartum hemorrhage in women with pre-eclampsia during C aesarean Section (CS). Patients and methods: This study included 120 pre-eclamptic pregnant women and were randomized (by alternation) into two groups of 60 patients: Group A received a single dose of carbetocin (100μg) diluted in 100ml 0.9% Nacl administered slowly over (30-60 seconds) intravenously after the delivery of the baby, while Group B received oxytocin (40 IU diluted in 100ml of 0.9% Nacl run at 25 ml per hour over 4 hours) intravenously after the delivery of baby. Results: Regarding preoperative hemoglobin and HCT, there was no statistically significant difference between the 2 studied groups. There were statistical significant differences between the 2 groups in postoperative hemoglobin and HCT with higher levels among Group A compared with Group B. There was significant increase in frequency of blood transfusion and need of other uterotonic drugs in oxytocin group compared with carbetocin group. No significant difference was observed between the 2 studied groups in frequency of headache, but there were statistically significant increase in frequency of nausea, vomiting, abdominal pain and oligourea in oxytocin group compared to carbetocin group. There was significant increase in frequency of elevated temperature in carbetocine group compared to oxytocin group. Conclusion: Carbetocin has a superior effect on oxytocin for prevention of postpartum hemorrhage in women with pre-eclampsia.