ADVANCED
LIFE SUPPORT
IN OBSTETRICS
COURSE MANUAL
10TH EDITION
10TH
EDITION — Manual 1 ®
,Editors Authors
Lawrence Leeman, MD, MPH Janice M. Anderson, MD, FAAFP Lawrence M. Leeman, MD, MPH
Medical Editor Postpartum Hemorrhage Hypertensive Disorders of Pregnancy,
Malpresentations, Malpositions,
Lee Dresang, MD R. Eugene Bailey, MD, FAAFP and Multiple Gestation, Perineal
Jeffrey D. Quinlan, MD, FAAFP Intrapartum Fetal Surveillance and Other Obstetric Lacerations,
Susanna R. Magee, MD, MPH Cesarean Delivery
Melissa Beagle, MD
Associate Medical Editors First-Trimester Pregnancy Paul Lewis, RM
Complications Birth Crisis
AAFP Staff
Rebecca L. Benko, MD, FAAFP Susanna R. Magee, MD, MPH,
Sarah Duranleau, MHA Preterm Labor and Prelabor Rupture FAAFP
Manager, Center for Women’s Health, of Membranes, Cesarean Delivery Assisted Vaginal Delivery
Health of the Public and Science
Division Mark Deutchman, MD, FAAFP Neil J. Murphy, MD
First-Trimester Pregnancy Trauma and Resuscitation in
Gaylynn Butts, BSN, RN Complications Pregnancy
Program Strategist, Editorial
Assistant, Health of the Public and Lee Dresang, MD Stephen Ratcliffe, MD, MSPH
Science Division Safety in Pregnancy Care, Venous Labor Dystocia
Thromboembolism in Pregnancy
Carla Cherry Jose A. Rojas-Suarez, MD
Program Specialist, Health of the Ann E. Evensen, MD, FAAFP Pregnancy-Related Sepsis
Public and Science Division Postpartum Hemorrhage, Labor
Dystocia Mary Beth Sutter, MD, FAAFP
Stefanie Olson
Assisted Vaginal Delivery
Program Specialist, Health of the Robert W. Gobbo, MD, FAAFP
Public and Science Division Shoulder Dystocia Barbara A. True, RN
Intrapartum Fetal Surveillance
Stef Stendardo Jessica T. Goldstein, MD, FAAFP
Managing Editor Cardiac Complications of Pregnancy Johanna B. Warren, MD
Shoulder Dystocia
Stacey Herrmann Gretchen Heinrichs, MD, OB/GYN
Production Design Manager, Late Pregnancy Bleeding Kerry Watrin, MD
Journal Media Division Preterm Labor and Prelabor Rupture
Kim Hinshaw, MBBS, FRCOG of Membranes
Randy Knittel Shoulder Dystocia
Senior Production Designer, Helen Welch, CNM
Journal Media Division Caroline S. Homer, MScMed, PhD Birth Crisis
Birth Crisis
R. Shawn Martin Nicole Yonke, MD, MPH, FAAFP
Executive Vice President and Paul Koch, MD Perineal and Other Obstetric
Chief Executive Officer Diagnostic Ultrasound in Labor and Lacerations
Delivery
Julie Wood, MD, FAAFP
Senior Vice President for Research,
Science & Health of the Public
Medical Illustrations by Lisa Clark
Conflicts of interest: It is the policy of the AAFP that all individuals in a position to control content disclose any relationships with
commercial interests upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflicts of
interest and, if identified, conflicts are resolved prior to confirmation of participation. Only those participants who had no conflict
of interest or who agreed to an identified resolution process prior to their participation were involved in this CME activity.
All other individuals in a position to control content for this activity have indicated they have no relevant financial relationships
to disclose.
— Manual i
,Preface Copyright
The ALSO Course is an educational program designed to The American Academy of Family Physicians (AAFP) owns
assist health professionals in developing and maintaining the ALSO copyright and trademark on all of the course
the knowledge and skills needed to effectively manage the materials, including the Manual, slide sets, and written
emergencies which arise in pregnancy care. The course exam. Use of portions of the materials outside of an autho-
includes required reading, lectures, and hands-on worksta- rized ALSO course is strictly prohibited without prior
tions. Evaluation is by a written exam and skills assessment written approval from the AAFP.
stations. There are many appropriate ways of managing
emergencies. The treatment guidelines presented in ALSO Course Disclaimer
do not necessarily represent the only way to manage prob- The material presented at this course is being made avail-
lems and emergencies. Instead, these guidelines are pre- able by the AAFP for educational purposes only. This
sented as reasonable methods of management in obstetrical material is not intended to represent the only, nor neces-
emergencies. Each pregnancy care clinician must ultimately sarily best, methods or procedures appropriate for the
exercise their own professional judgement in deciding on medical situations discussed, but rather is intended to
appropriate action in emergency situations. Completion of present an approach, view, statement, or opinion of the
the ALSO Course does not imply competency to perform faculty which may be helpful to others who face simi-
the procedures discussed in the course materials. lar situations. The AAFP disclaims any and all liability
for injury, or other damages, resulting to any individual
Overall Course Objectives attending this course and for all claims which may arise
• Discuss methods of managing pregnancy and birth out of the use of the techniques demonstrated therein by
urgencies and emergencies, which standardizes the skills such individuals, whether these claims shall be asserted
of practicing pregnancy care providers. by a physician, or any other person. Every effort has been
• Demonstrate content and skill acquisition as evidenced made to ensure the accuracy of the data presented at
by successful completion of course examination, skills this course. Physicians may care to check specific details,
workstations, and group testing stations. such as drug doses and contraindications, etc, in stan-
• Provide safe team leadership through various emergency dard sources prior to clinical application. The AAFP does
obstetric scenarios. not certify competence upon completion of the ALSO
• Demonstrate effective team communication strategies Course, nor does it intend this course to serve as a basis
focusing on patient safety. for requesting new or expanded privileges.
The American Academy of Family Physicians (AAFP) under the leadership of Dr Damos and John W. Beasley,
wishes to acknowledge the initial development of the ALSO MD. The AAFP acquired the ALSO Program in 1993.
Program by the University of Wisconsin Department of The curriculum demonstrates the evidence, and quality
Family Medicine and the original national ALSO Develop- of that evidence, on which any recommendations of care
ment Group of family physicians, obstetricians, and nurses, are based.
which formed in 1991. The ALSO Program, originally The current ALSO Manual continues to be an ongoing
conceptualized by James R. Damos, MD, was developed process and is reviewed on a 3-year cycle.
© 2023 American Academy of Family Physicians
11400 Tomahawk Creek Parkway, Leawood, Kansas 66211-2672
1-800-274-2237 • 913-906-6000
ii Manual —
, Advanced Life Support in Obstetrics (ALSO®)
Status Life Cycle
ALSO Instructor ALSO Approved
ALSO Candidate Instructor ALSO Advisory
3-year status Successfully complete
3-year status Faculty
Successfully an ALSO Instructor Instruct in two courses Maintain Approved
complete an Course and be (ALSO and/or BLSO) Instructor status to
ALSO Course evaluated within and complete the maintain Advisory
one year Online Instructor Faculty status
Renewal Course every
three years
Wallet Cards include status start and expiration dates and
can be accessed in AAFP accounts/transcripts.
Please review the ALSO Guidelines document
at www.aafp.org/also for further details.
To find out more about the ALSO program and
upcoming courses, please visit www.aafp.org/also.
— Manual iii
LIFE SUPPORT
IN OBSTETRICS
COURSE MANUAL
10TH EDITION
10TH
EDITION — Manual 1 ®
,Editors Authors
Lawrence Leeman, MD, MPH Janice M. Anderson, MD, FAAFP Lawrence M. Leeman, MD, MPH
Medical Editor Postpartum Hemorrhage Hypertensive Disorders of Pregnancy,
Malpresentations, Malpositions,
Lee Dresang, MD R. Eugene Bailey, MD, FAAFP and Multiple Gestation, Perineal
Jeffrey D. Quinlan, MD, FAAFP Intrapartum Fetal Surveillance and Other Obstetric Lacerations,
Susanna R. Magee, MD, MPH Cesarean Delivery
Melissa Beagle, MD
Associate Medical Editors First-Trimester Pregnancy Paul Lewis, RM
Complications Birth Crisis
AAFP Staff
Rebecca L. Benko, MD, FAAFP Susanna R. Magee, MD, MPH,
Sarah Duranleau, MHA Preterm Labor and Prelabor Rupture FAAFP
Manager, Center for Women’s Health, of Membranes, Cesarean Delivery Assisted Vaginal Delivery
Health of the Public and Science
Division Mark Deutchman, MD, FAAFP Neil J. Murphy, MD
First-Trimester Pregnancy Trauma and Resuscitation in
Gaylynn Butts, BSN, RN Complications Pregnancy
Program Strategist, Editorial
Assistant, Health of the Public and Lee Dresang, MD Stephen Ratcliffe, MD, MSPH
Science Division Safety in Pregnancy Care, Venous Labor Dystocia
Thromboembolism in Pregnancy
Carla Cherry Jose A. Rojas-Suarez, MD
Program Specialist, Health of the Ann E. Evensen, MD, FAAFP Pregnancy-Related Sepsis
Public and Science Division Postpartum Hemorrhage, Labor
Dystocia Mary Beth Sutter, MD, FAAFP
Stefanie Olson
Assisted Vaginal Delivery
Program Specialist, Health of the Robert W. Gobbo, MD, FAAFP
Public and Science Division Shoulder Dystocia Barbara A. True, RN
Intrapartum Fetal Surveillance
Stef Stendardo Jessica T. Goldstein, MD, FAAFP
Managing Editor Cardiac Complications of Pregnancy Johanna B. Warren, MD
Shoulder Dystocia
Stacey Herrmann Gretchen Heinrichs, MD, OB/GYN
Production Design Manager, Late Pregnancy Bleeding Kerry Watrin, MD
Journal Media Division Preterm Labor and Prelabor Rupture
Kim Hinshaw, MBBS, FRCOG of Membranes
Randy Knittel Shoulder Dystocia
Senior Production Designer, Helen Welch, CNM
Journal Media Division Caroline S. Homer, MScMed, PhD Birth Crisis
Birth Crisis
R. Shawn Martin Nicole Yonke, MD, MPH, FAAFP
Executive Vice President and Paul Koch, MD Perineal and Other Obstetric
Chief Executive Officer Diagnostic Ultrasound in Labor and Lacerations
Delivery
Julie Wood, MD, FAAFP
Senior Vice President for Research,
Science & Health of the Public
Medical Illustrations by Lisa Clark
Conflicts of interest: It is the policy of the AAFP that all individuals in a position to control content disclose any relationships with
commercial interests upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflicts of
interest and, if identified, conflicts are resolved prior to confirmation of participation. Only those participants who had no conflict
of interest or who agreed to an identified resolution process prior to their participation were involved in this CME activity.
All other individuals in a position to control content for this activity have indicated they have no relevant financial relationships
to disclose.
— Manual i
,Preface Copyright
The ALSO Course is an educational program designed to The American Academy of Family Physicians (AAFP) owns
assist health professionals in developing and maintaining the ALSO copyright and trademark on all of the course
the knowledge and skills needed to effectively manage the materials, including the Manual, slide sets, and written
emergencies which arise in pregnancy care. The course exam. Use of portions of the materials outside of an autho-
includes required reading, lectures, and hands-on worksta- rized ALSO course is strictly prohibited without prior
tions. Evaluation is by a written exam and skills assessment written approval from the AAFP.
stations. There are many appropriate ways of managing
emergencies. The treatment guidelines presented in ALSO Course Disclaimer
do not necessarily represent the only way to manage prob- The material presented at this course is being made avail-
lems and emergencies. Instead, these guidelines are pre- able by the AAFP for educational purposes only. This
sented as reasonable methods of management in obstetrical material is not intended to represent the only, nor neces-
emergencies. Each pregnancy care clinician must ultimately sarily best, methods or procedures appropriate for the
exercise their own professional judgement in deciding on medical situations discussed, but rather is intended to
appropriate action in emergency situations. Completion of present an approach, view, statement, or opinion of the
the ALSO Course does not imply competency to perform faculty which may be helpful to others who face simi-
the procedures discussed in the course materials. lar situations. The AAFP disclaims any and all liability
for injury, or other damages, resulting to any individual
Overall Course Objectives attending this course and for all claims which may arise
• Discuss methods of managing pregnancy and birth out of the use of the techniques demonstrated therein by
urgencies and emergencies, which standardizes the skills such individuals, whether these claims shall be asserted
of practicing pregnancy care providers. by a physician, or any other person. Every effort has been
• Demonstrate content and skill acquisition as evidenced made to ensure the accuracy of the data presented at
by successful completion of course examination, skills this course. Physicians may care to check specific details,
workstations, and group testing stations. such as drug doses and contraindications, etc, in stan-
• Provide safe team leadership through various emergency dard sources prior to clinical application. The AAFP does
obstetric scenarios. not certify competence upon completion of the ALSO
• Demonstrate effective team communication strategies Course, nor does it intend this course to serve as a basis
focusing on patient safety. for requesting new or expanded privileges.
The American Academy of Family Physicians (AAFP) under the leadership of Dr Damos and John W. Beasley,
wishes to acknowledge the initial development of the ALSO MD. The AAFP acquired the ALSO Program in 1993.
Program by the University of Wisconsin Department of The curriculum demonstrates the evidence, and quality
Family Medicine and the original national ALSO Develop- of that evidence, on which any recommendations of care
ment Group of family physicians, obstetricians, and nurses, are based.
which formed in 1991. The ALSO Program, originally The current ALSO Manual continues to be an ongoing
conceptualized by James R. Damos, MD, was developed process and is reviewed on a 3-year cycle.
© 2023 American Academy of Family Physicians
11400 Tomahawk Creek Parkway, Leawood, Kansas 66211-2672
1-800-274-2237 • 913-906-6000
ii Manual —
, Advanced Life Support in Obstetrics (ALSO®)
Status Life Cycle
ALSO Instructor ALSO Approved
ALSO Candidate Instructor ALSO Advisory
3-year status Successfully complete
3-year status Faculty
Successfully an ALSO Instructor Instruct in two courses Maintain Approved
complete an Course and be (ALSO and/or BLSO) Instructor status to
ALSO Course evaluated within and complete the maintain Advisory
one year Online Instructor Faculty status
Renewal Course every
three years
Wallet Cards include status start and expiration dates and
can be accessed in AAFP accounts/transcripts.
Please review the ALSO Guidelines document
at www.aafp.org/also for further details.
To find out more about the ALSO program and
upcoming courses, please visit www.aafp.org/also.
— Manual iii
