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Increase in Mallampati score during pregnancy
S Pilkington1, F Carli, M J Dakin
1Division of Anaesthesia, Northwick Park Hospital and Clinical Research Centre, Harrow.
British Journal of Anaesthesia
|June 1, 1995
Summary
A photographic Mallampati test showed a 34% increase in grade 4 cases in pregnant patients by 38 weeks gestation. This suggests pharyngeal edema impacts tracheal intubation difficulty in obstetrics, though not fully explaining reported failure rates.
Area of Science:
- Anesthesiology
- Obstetrics
- Airway Management
Background:
- Difficult laryngoscopy is a concern in obstetric anesthesia.
- The Mallampati test is used to predict airway difficulty.
- Pregnancy-induced physiological changes may affect airway anatomy.
Purpose of the Study:
- To evaluate changes in Mallampati scores during pregnancy.
- To correlate Mallampati score changes with gestational age and weight gain.
- To assess the impact of these changes on predicted airway difficulty in obstetrics.
Main Methods:
- A photographic Mallampati test was developed.
- 242 pregnant patients were assessed at 12 and 38 weeks gestation.
- Mallampati scores were correlated with gestational age and weight gain.
Main Results:
- A 34% increase in Mallampati grade 4 cases was observed by 38 weeks gestation (P < 0.001).
- The increase in Mallampati score correlated with body weight gain (r = 0.3, P < 0.001).
- Difficult laryngoscopy rates in obstetrics (1.7%) were slightly higher than in general surgery (1.3%).
Conclusions:
- Pharyngeal edema during pregnancy may contribute to tracheal intubation difficulty.
- Weight gain and fluid retention are potential causes for increased Mallampati scores.
- Further research is needed on factors affecting the Mallampati test, including neck extension, to rationalize difficult intubation management.