Abstract 
Objective: To assess the effectiveness of oxytocin compared to carbetocin in patients with high risk factors for atonic postpartum hemorrhage who are undergoing elective caesarean section for prophylaxis against postpartum hemorrhage. 
Subjects and methods: This randomized controlled study was conducted on 100 pregnant women undergoing elective caesarean section and had high risk factors for atonic PPH. Group (1): were given oxytocin 10 (IU) and Group (2):  were given 1 ml of carbetocin. The study was approved by the Ethics Committee, and all patients gave their informed consent before inclusion in the study.  
Results: We found that there was a statistically significant differences between the two groups as regard the need for additional uterotonic agents, need for uterine massage, estimated mean operative blood loss, hemoglobin 24 hours after operation and incidence of major obstetric hemorrhage (P-value < 0.05).  
Conclusion: The current study has demonstrated that carbetocin can be alternative to traditional oxytocin in the prevention of postpartum hemorrhage in high-risk women undergoing elective caesarean section.