Background: Research from the literature indicates that the likelihood of postpartum hemorrhage (PPH) is one of the most harmful aspects to take into account when preparing for a twin delivery. Objective: Our foremost objective was to compare the effectiveness and adverse effects of carbetocin with oxytocin in preventing postpartum hemorrhage (PPH) in twin pregnant women following elective cesarean section (CS). Study design: In this randomized controlled study, 118 pregnant women with twin pregnancies who were admitted for an elective cesarean section in two equal groups, were given intravenous slow IV boluses of carbetocin (group A) and slow intravenous oxytocin boluses (10 IU) (group B). Following the delivery of the second fetus, all patients were given the study medications. Results: The need for additional uterotonics was statistically higher in group B than in group A; 5 (24.3%) versus 15 (13.1%) with P-value 0.025. While the estimated blood loss was statistically insignificant between both groups (928.5 ± 146.4 ml in (group A) versus 941.2 ±277.2 ml in (group B), with P-value 0.311. As such, incidence of PPH was statistically insignificantly different between study groups (p value 0.239). Conclusion: The use of carbetocin at elective cesarean section for twin pregnancy is not superior to slow IV oxytocin bolus in reducing the operative blood loss or prevention of PPH but it may reduce the postoperative need for additional uterotonics, especially in IVF twin gestation.