Increase in Mallampati score during pregnancy

• Published in: British journal of anaesthesia : BJA 1995-06, Vol.74 (6), p.638-642
• Main Authors: PILKINGTON, S., CARLI, F., DAKIN, M.J., ROMNEY, M., DE WITT, K.A., DORé, C.J., CORMACK, R.S.
• Format: Article
• Language: English
• Subjects: Abdominal surgery. Urology. Gynecology. Obstetrics; Anaesthesia; Anaesthesia, obstetric; Anesthesia; Anesthesia depending on type of surgery; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anthropometry; Biological and medical sciences; Body Weight; Female; Humans; Intubation; Intubation, Intratracheal; Intubation, tracheal Pregnancy; Laryngeal Edema - complications; Laryngoscopy; Medical sciences; obstetric; Pharynx - pathology; Pregnancy - physiology; Reproducibility of Results; Time Factors; tracheal Pregnancy
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/74.6.638

A photographic version of the Mallampati test was developed and applied to 242 pregnant patients at 12 weeks′ gestation and again at 38 weeks′ gestation. At 38 weeks the number of grade 4 cases had increased by 34% (P > 0.001). This is in agreement with other evidence which suggests that difficult laryngoscopy is slightly more frequent in obstetrics (1.7%) than in general surgery (1.3%). The increase in Mallampati score correlated with gain in body weight (r = 0.3, P > 0.001), which gives some support to the concept that fluid retention is the underlying cause. We conclude that pharyngeal oedema causes some hindrance to tracheal intubation in obstetrics, but not enough to explain the high failure rate reported. A case is made for rationalizing the management of difficult intubation. Our data also show that more research is needed on factors which affect Mallampati's test, particularly neck extension.