Airway problems and changing Mallampati score during pregnancy and labor: a systematic review
Bibliographic record
Abstract
BACKGROUND: During pregnancy, labor, and postpartum, physiological changes such as weight gain, hormonal fluctuations, or fluid retention may cause airway edema and soft tissue swelling. These factors impact Mallampati Classification, a predictive tool to investigate airway. A higher Mallampati class indicates a high-risk obstetric population. This systematic review explores the airway and Mallampati modification during the different pregnancy periods. Understanding the airway changes in pregnancy is critical to safely intubate, avoid adverse outcomes in maternal care and support clinical practice. METHODOLOGY: Research started using five databases, from the beginning to January 2025: Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, and ClinicalTrial.gov, with the following search terms: "Mallampati", "Mallampati grading", "Airway", "Airway changes", "Airway Obstruction", "pregnancy", "Delivery, Obstetric", "Anesthesia, Obstetrical". Articles included only studies covering a change in the Mallampati classification in pregnancy, labor, or postpartum. All the studies that did not concern airway changes in pregnancy or did not include a Mallampati classification were excluded. The quality of the included studies was assessed using a modified Newcastle-Ottawa Scale. RESULTS: Ten articles met the inclusion criteria. Significant changes in Mallampati class during pregnancy, labor, and post-partum were evidenced. Grades III and IV of Mallampati Classification increased during pregnancy, reaching 51.7% at delivery, compared to 10.3% pre-pregnancy. Increased proportions of MMC III/IV were observed among women with hypertensive and preeclampsia conditions when compared with the normotensive population. During the postpartum, the Mallampati class partially receded toward pre-pregnancy levels, with approximately 82% returning to baseline within 36 to 48 h. CONCLUSION: These findings evidenced the pregnancy-related airway changes and their dynamic process, highlighting the need for close vigilance, especially during labor in high-risk populations. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42025635304.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.028 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.008 |
| Bibliometrics | 0.010 | 0.013 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".