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Change in Mallampati class during labor: hypertensive versus normotensive parturient
Abstract Number: S2A-4
Abstract Type: Original Research
Background: Airway changes due to soft tissue edema are an invariable association of pregnancy, which have shown to further aggravate during the course of labor and delivery.1 Such alterations are speculated to be more pronounced in patients with hypertensive disorders.2 Mallampati classification is used as airway assessment tool to quantify airway changes.2 One study, conducted by Boutonnet and colleagues demonstrated a 3.5 fold increase in patients with Mallampati class 3 or 4 during labor as compared to pre-labor, however they had an insignificant number of participants with hypertensive disorders (3/87), hence preventing them from analyzing this subgroup.3
No study has specifically examined the extent of airway changes in this peculiar patient population during labor. Therefore, in order to evaluate the magnitude of problem in hypertensive parturients, this study is aimed to compare the frequency of change in Mallampati class during labor in parturients with hypertensive disorders compared to normotensive parturients.
Methods: In this prospective observational cohort study, 60 parturient were enrolled and divided into two groups of 30 each: hypertensive parturient (Group H) and normotensive parturient (Group N). The Mallampati class was evaluated in each parturient at two points; during early labor (cervical dilation 1-3 cm and regular contractions) taken as T1 and at 20 minutes after delivery taken as T2. The change in Mallampati class from T1 to T2 was compared between the two groups. Post stratification chi-square test was applied and P value <0.05 was considered as significant.
Results: Overall, a tendency towards increase in Mallampati class during labor was identified with statistically significant difference between the hypertensive and normotensive group (80% vs. 40%; p=0.002). The change in Mallampati class was observed to be significantly higher in group H as compared to group N (80% vs. 46.7%; p=0.007). Risk of increase in Mallampati class was 2 times more likely in hypertensive women as compared to normotensive [Relative risk (RR) =2; 95%CI: 1.25 to 3.21].
Conclusion: Mallampati class showed 2 fold increase in hypertensive compared to normotensive parturient during labor; requiring additional caution during airway management.
1. Kodali BS, Chandrasekhar S, Bulich LN, Topulos GP, Datta S. Airway changes during labor and delivery. Anesthesiology 2008; 108: 357–62.
2. Guru R, Carere MD, Diwan S, Morau EL, Saunders J, Shorten GD. Effect of epidural analgesia on change in Mallampati class during labour. Anaesthesia 2013; 68: 765-9.
3. Boutonnet M, Faitot V, Katz A, Salomon L, Keita H. Mallampati class changes during pregnancy, labour, and after delivery: can these be predicted? Br J Anaesth 2010; 104:67 –70.