Changing Mallampati score during labour

  • Erlina L. Farcon
  • Marvin H. Kim
  • Gertie F. Marx
Clinical Reports

Abstract

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.

Key words

Airway: assessment Anaesthesia: obstetric Larynx: oedema 

Résumé

Nous présentons un cas de variation du score de Mallampati pendant le travail d’une primigeste bien portante. A l’admission, son airway est classé I–II sur l’échelle de Mallampati. Avec une dilatation cervicale de 5 cm, la patiente se met à pousser vigoureusement malgré sa connaissance du danger inhérent à un tel effort. A 8 cm de dilatation, on envisage une césarienne pour cause de décélérations du coeur foetal. Des évaluation répétées de l’airway révèlent un oedème important du pharynx inférieur qui fait passer le score de Mallampati à III–IV. Finalement, avec l’amélioration du tracé foetal, on accouche la patiente par voie vaginale sous infiltration locale. Au postpartum, le Mallampati est toujours à III–IV Cependant, 12 heures plus tard, on constate que le score de Mallampati redevient I–II comme à l’admission. Nous recommandons de toujours réévaluer l’airway d’une parturiente avant l’induction de l’anesthésie générale, même si cet examen a déjà été fait à l’admission.

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Copyright information

© Canadian Anesthesiologists 1994

Authors and Affiliations

  • Erlina L. Farcon
    • 1
  • Marvin H. Kim
    • 1
  • Gertie F. Marx
    • 1
  1. 1.Department of AnesthesiologyAlbert Einstein College of Medicine - Jacobi 1226BronxUSA

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