Date Published

October 23, 2023

Updated For

ALS PCS Version 5.2


Early recognition and management of Shoulder Dystocia is key in mitigation of critical irreversible hypoxic injury in newborns. Remember to watch for tell-tale “turtle sign”, when the head emerges and then retracts against the perineum, due to the shoulder stuck on the maternal symphysis pubis (anterior shoulder) or sacral promontory (posterior shoulder).

Then use the ALARM pneumonic to manage these critical deliveries:

A: Ask for help (You will require 2 people)

L: Lift legs, hyperflex thighs (McRoberts Maneuver)

A: Adduct shoulder (Apply suprapubic pressure

R: Roll over (Gaskins Maneuver)

M: Manually delivery of posterior arm (if visible at the perineum)


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