Background: Postpartum hemorrhage (PPH) is a significant cause of maternal morbidity and mortality. This study aimed to evaluate and compare between carbetocin & oxytocin for post-partum haemorrhage prophylaxis among high-risk women giving birth through Vaginal Delivery and Caesarean Section. Methods: total of 200 singleton pregnant women with at least one risk factor for atonic PPH were included in the study. They were randomly assigned to two groups: Group A received carbetocin (n=100) and Group B received oxytocin (n=100). Clinical assessments, including blood pressure monitoring, blood loss measurement, and changes in hemoglobin concentrations, were conducted. Maternal demographics, risk factors, and outcomes such as PPH, need for additional uterotonics, and blood transfusion were analyzed. Results: Postpartum, both groups experienced increased pulse and blood pressure, with the oxytocin group showing considerably higher systolic and diastolic blood pressure (P-value < 0.001). Hemoglobin and hematocrit levels considerably decreased postpartum, with the oxytocin group exhibiting greater decreases (P-value < 0.001). Estimated blood loss, PPH incidence, and the need for additional uterotonics and blood transfusion were considerably lower in the carbetocin group (P-value < 0.001). Uterine tone was considerably better in the carbetocin group compared to the oxytocin group (P-value < 0.001). Conclusions: Carbetocin demonstrated superior efficacy in reducing blood loss and preventing PPH compared to oxytocin among high-risk women undergoing vaginal delivery and cesarean section.