Background: Postpartum hemorrhage (PPH) responsible for twenty to twenty five percent of maternal mortality. The major PPH mechanism is uterine atony, as it is active in fifty nine percent of pregnant. The use of uterotonics after birth is implicit in its avoidance. Objective: To evaluate the effect of carbetocin in prevention of PPH after cesarean section in pregnant with severe preeclampsia (PE) in comparison to oxytocin. Patients and Methods: This study involved 100 pregnant with severe PE with gestational age between 28 and 40 weeks. The patients were divided into two equal groups: group (A) received 100 microgram carbetocin dissolved in 5 ml saline 0.9% direct I.V over 3 minutes, and group (B) received 40 i.u oxytocin I.V infusion. Results: In carbetocin cases, 30 pregnant needed misoprostol to gain a good uterine contraction. In oxytocin cases, although a sustained infusion, ten pregnant had another oxytocin dose, and ten pregnant needed misoprostol dose. Also, prevalence of extra uterotonic doses in the carbetocin and oxytocin cases was 60% and 40%, respectively (P = 0.021). Oxytocin cases had significantly higher mean of period from oxytocin to misoprostol than carbetocin cases (p=0.001). Conclusion: Carbetocin has the same efficacy and safety of oxytocin in PE. Since it´s easy to administer, it needs a relatively small vehicle capability and has a long-lasting uterotonic efficacy.