الفهرس 
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Abstract
Introduction : Postpartum hemorrhage (PPH) is a significant cause of maternal morbidity and mortality. PPH is caused mainly by uterine atony and occur in the immediate postpartum period (1). Postpartum hemorrhage is the leading cause of direct maternal death in poor and developing countries. The incidence of PPH may range from less than 5% to more than 10%.The figures remain at least 100 times higher than those in developed countries. Two third of postpartum hemorrhage cases occur without any predisposing factors. Several drugs reduce postpartum hemorrhage by causing uterus to contract. Ergot derivatives have been used for decades, in spite that oxytocin is the drug of choice in some centers. Patient and methods : This study took place in Mansoura University Hospital, Obstetrics and Gynecology department, and Mansoura New General Hospital, Obstetrics and Gynecology department, during the period between April 2017 and April 2018. The study was approved by The Local Ethical and Research Committee of Mansoura University and written informed consent was obtained from Conclusion: Carbetocin is superior to Oxytocin and Misoprostol in preventing and minimizing incidence of atonic postpartum hemorrhage in patients performing elective caesarean delivery with high risk factors. Carbetocin is solely efficient in controlling postpartum hemorrhage and is associated with less need for further uterotonic agents or surgical haemostatic measures in comparison to Oxytocin and Misoprostol groups. It produces prolonged uterine tetanic spasm during and post cesarean delivery in comparison to Oxytocin and Misoprostol.