Background: Postpartum hemorrhage (PPH) is a serious condition remaining the single main cause of maternal morbidity and mortality. Objective: To compare the prophylactic effects of carbetocin with those of oxytocin in the prevention of atonic PPH in patients undergoing repeated elective cesarean section (CS) under spinal anesthesia. Patients and Methods: This comparative study was conducted on 100 pregnant women after 38 weeks underwent elective cesarean section under spinal anesthesia at Al- Azhar University Hospitals (Al- Hussein and Bab Al- Shaaria Hospitals) from April 2019 to October 2020, 50 patients received a single dose of 100 microgram intravenous carbetocin, the other 50 patients received 5 IU of oxytocin IV followed by 20-40 IU of oxytocin infusion on 1000 ml saline with a rate of 150 ml per hour. Results: Patients who received carbetocin developed less major obstetric hemorrhage, required less intervention in the form of uterine massage and less additional uterotonic agents than those received oxytocin. The estimated blood loss was significantly lower in the carbetocin group than the oxytocin group. Also, the carbetocin group showed less incidence of severe anemia and the need for blood transfusion than oxytocin but that was statistically insignificant. Conclusion: Carbetocin appeared to be effective or more as oxytocin for prevention of atonic postpartum hemorrhage in patients undergoing elective cesarean section. Carbetocin reduced the use of additional oxytocics following cesarean section when compared with the licensed dose of oxytocin (5 IU). Also, carbetocin improved the hemodynamic states of the patients, decreased the need for blood transfusion and incidence of severe anemia.