Changing Mallampati score during labour.
We present the case of a changing Mallampati score during the course of labour in a healthy primigravida. On admission to hospital, the airway was assessed as Mallampati class I-II. At 5 cm cervical dilation, the woman began to bear down strenuously and continued this despite being advised of the inherent hazard. At 8 cm dilation, Caesarean delivery was contemplated because of fetal heart rate decelerations. Repeat airway evaluation revealed marked oedema of the lower pharynx giving rise to a Mallampati score of III-IV. Improvement of the fetal heart rate tracing permitted vaginal delivery under local infiltration. Postpartum, the Mallampati score was still III-IV. However, 12 hr later it had returned to the admission classification of I-II. We recommend that, in addition to the usual airway evaluation on admission, the assessment be repeated in the obstetric patient before induction of general anaesthesia.
Farcon
E L
EL
Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, New York 10461.
Kim
M H
MH
Marx
G F
GF
D000328:Adult; D000402:Airway Obstruction / Q000145:classification* / Q000209:etiology*; D000768:Anesthesia, General; D000773:Anesthesia, Obstetrical; D000075202:Contraindications; D004487:Edema / Q000150:complications*; D005260:Female; D006801:Humans; D009321:Natural Childbirth / Q000009:adverse effects*; D007744:Obstetric Labor Complications; D010608:Pharyngeal Diseases / Q000150:complications*; D011247:Pregnancy