Background: Approximately 16%-25% of pregnancies are complicated by first trimester bleeding. The wide range of causes of early pregnancy bleeding, threat to loss the pregnancy and fear of having any life threatening cause puts pregnant female with first trimester bleeding into the state of uncertainty which leads to anxiety and depression. The objective of this study was to determine fetal outcome in women presenting with per vaginal bleeding in first trimester of pregnancy.Methods: This prospective observational study was carried out on 75 women presenting with complain of first trimester bleeding at Kulsumbai Valika hospital, a tertiary care hospital located in SITE area Karachi, Pakistan from July 2019 to July 2020 for a period of 1 year. A Performa was designed to collect information and patient followed until pregnancy is terminated.Results: The majority of participants presented at 8th week of gestation. Out of 75 participants who presented with first trimester bleeding 40% ended up in miscarriage. 6% had ectopic, 2% had molar pregnancy, 4% had placenta previa, 6% had preterm birth and 40% had healthy infant at the end of pregnancy.Conclusions: Bleeding in pregnancy is a red flag sign and needs to be addressed with wise approach to have optimal possible maternal and fetal outcomes.

Background: Breech presentation is found in 3-5% of pregnant women at term. The cause for this fetal presentation may vary from fetal to maternal. Management option for breech presentation includes assisted vaginal breech birth, caesarean section and external cephalic version. External cephalic version is a maneuver performed to avoid breech presentation at term labor and helping the obstetricians to avoid complications of cesarean section. The success rate of ECV is 50%. Considering a high success rate and low risks it can be concluded that ECV can help reduce cesarean section rate of any region. The objective of this study is to determine the knowledge, attitude and practice of healthcare practitioners towards external cephalic version.Methods: This is an observational cross-sectional study conducted by the postgraduate trainee of Kulsumbai Valika social security SITE hospital, Karachi, Pakistan. By purposive sampling selection, there were 50 consultant obstetricians that have been well informed and were willing to complete KAP study questionnaires were enrolled to participate.Results: A total of 50 participants were included, 70% had clinical experience of more than 10 years. 80% considered ECV a safe procedure.75% believe that effective knowledge and practice of ECV can bring down cesarean section rate. If encountered by client with breech presentation 69% will manage with elective LSCS (lower segment caesarean section), 26% with ECV and only 5% will manage with assisted breech vaginal birth.Conclusions: For uncomplicated singleton breech at term, both ACOG and RCOG recommend external cephalic version. In Pakistan the current trend involves performing cesarean section for breech presentation. Effective knowledge, Proper training, and adequate practice can improve ECV uptake in our country.