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Am J Perinatol 2015; 32(03): 257-262
DOI: 10.1055/s-0034-1383845
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Use of a Simple Clinical Tool for Airway Assessment to Predict Adverse Pregnancy Outcomes

Amanda S. Trudell
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
,
Judette M. Louis
2   Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida
,
Methodius G. Tuuli
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
,
Aaron B. Caughey
3   Department of Obstetrics and Gynecology, Oregon Health and Sciences University, Portland, Oregon
,
Anthony O. Odibo
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
,
Alison G. Cahill
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
› Author Affiliations
Further Information

Publication History

13 February 2014

13 May 2014

Publication Date:
27 June 2014 (online)

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Abstract

Objective Obstructive sleep apnea (OSA) is a risk factor for adverse perinatal outcomes. We aimed to test the hypothesis that maternal Mallampati class (MC), as a marker for OSA, is associated with adverse perinatal outcomes.

Study Design We performed a retrospective secondary analysis of a prospective cohort of term births (≥ 37 weeks). Fetal anomalies and aneuploidy were excluded. Primary outcome was small for gestational age (SGA). Secondary outcomes included preeclampsia, neonatal cord arterial blood gas pH < 7.10 and < 7.05, base excess <  − 8 and <  − 12 mEq/L. Outcomes were compared between mothers with low MC airways and high MC airways using logistic regression.

Results A total of 1,823 women met the inclusion criteria. No significant differences were found in the risk of SGA (adjusted odds ratio [aOR] 0.9, 95% confidence interval [CI] 0.6–1.2), preeclampsia (aOR 1.2, 95% CI 0.8–1.9) or neonatal acidemia (aOR 0.8, 95% CI 0.3–2.0), between high and low MC.

Conclusion High MC is not associated with adverse perinatal outcomes.

Keywords

Mallampati - obstructive sleep apnea - OSA - small for gestational age - sleep disordered breathing
 

  • References

  • 1 Punjabi NM, Sorkin JD, Katzel LI, Goldberg AP, Schwartz AR, Smith PL. Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir Crit Care Med 2002; 165 (5) 677-682
    CrossrefPubMedGoogle Scholar
  • 2 Chasens ER. Obstructive sleep apnea, daytime sleepiness, and type 2 diabetes. Diabetes Educ 2007; 33 (3) 475-482
    CrossrefPubMedGoogle Scholar
  • 3 Punjabi NM, Beamer BA. C-reactive protein is associated with sleep disordered breathing independent of adiposity. Sleep 2007; 30 (1) 29-34
    PubMedGoogle Scholar
  • 4 Somers VK, White DP, Amin R , et al. Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing. J Am Coll Cardiol 2008; 52 (8) 686-717
    CrossrefPubMedGoogle Scholar
  • 5 Olivarez SA, Ferres M, Antony K , et al. Obstructive sleep apnea screening in pregnancy, perinatal outcomes, and impact of maternal obesity. Am J Perinatol 2011; 28 (8) 651-658
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Fung AM, Wilson DL, Barnes M, Walker SP. Obstructive sleep apnea and pregnancy: the effect on perinatal outcomes. J Perinatol 2012; 32 (6) 399-406
    CrossrefPubMedGoogle Scholar
  • 7 Louis JM, Auckley D, Sokol RJ, Mercer BM. Maternal and neonatal morbidities associated with obstructive sleep apnea complicating pregnancy. Am J Obstet Gynecol 2010; 202 (3) e1-e5
    PubMedGoogle Scholar
  • 8 Chen YH, Kang JH, Lin CC, Wang IT, Keller JJ, Lin HC. Obstructive sleep apnea and the risk of adverse pregnancy outcomes. Am J Obstet Gynecol 2012; 206 (2) e1-e5
    CrossrefPubMedGoogle Scholar
  • 9 Louis J, Auckley D, Miladinovic B , et al. Perinatal outcomes associated with obstructive sleep apnea in obese pregnant women. Obstet Gynecol 2012; 120 (5) 1085-1092
    PubMedGoogle Scholar
  • 10 Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 1999; 22 (5) 667-689
    PubMedGoogle Scholar
  • 11 Chervin RD, Murman DL, Malow BA, Totten V. Cost-utility of three approaches to the diagnosis of sleep apnea: polysomnography, home testing, and empirical therapy. Ann Intern Med 1999; 130 (6) 496-505
    CrossrefPubMedGoogle Scholar
  • 12 Epstein LJ, Dorlac GR. Cost-effectiveness analysis of nocturnal oximetry as a method of screening for sleep apnea-hypopnea syndrome. Chest 1998; 113 (1) 97-103
    CrossrefPubMedGoogle Scholar
  • 13 Mallampati SR, Gatt SP, Gugino LD , et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 1985; 32 (4) 429-434
    CrossrefPubMedGoogle Scholar
  • 14 Samsoon GL, Young JR. Difficult tracheal intubation: a retrospective study. Anaesthesia 1987; 42 (5) 487-490
    CrossrefPubMedGoogle Scholar
  • 15 Friedman M, Hamilton C, Samuelson CG, Lundgren ME, Pott T. Diagnostic Value of the Friedman tongue position and Mallampati classification for obstructive sleep apnea: a meta-analysis. Otolaryngol Head Neck Surg 2013; 148 (4) 540-547
    CrossrefPubMedGoogle Scholar
  • 16 Nuckton TJ, Glidden DV, Browner WS, Claman DM. Physical examination: Mallampati score as an independent predictor of obstructive sleep apnea. Sleep 2006; 29 (7) 903-908
    PubMedGoogle Scholar
  • 17 Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M. A United States national reference for fetal growth. Obstet Gynecol 1996; 87 (2) 163-168
    CrossrefPubMedGoogle Scholar
  • 18 Brown MA, Lindheimer MD, de Swiet M, Van Assche A, Moutquin JM. The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertens Pregnancy 2001; 20 (1) IX-XIV
    CrossrefPubMedGoogle Scholar
  • 19 Hosmer D, Lemeshow S. Applied Logistic Regression. New York, NY: John Wiley & Sons; 2001: 147-156
    Google Scholar
  • 20 Maasilta P, Bachour A, Teramo K, Polo O, Laitinen LA. Sleep-related disordered breathing during pregnancy in obese women. Chest 2001; 120 (5) 1448-1454
    CrossrefPubMedGoogle Scholar
  • 21 Pien GW, Schwab RJ. Sleep disorders during pregnancy. Sleep 2004; 27 (7) 1405-1417
    PubMedGoogle Scholar
  • 22 Liistro G, Rombaux P, Belge C, Dury M, Aubert G, Rodenstein DO. High Mallampati score and nasal obstruction are associated risk factors for obstructive sleep apnoea. Eur Respir J 2003; 21 (2) 248-252
    CrossrefPubMedGoogle Scholar
  • 23 Hiremath AS, Hillman DR, James AL, Noffsinger WJ, Platt PR, Singer SL. Relationship between difficult tracheal intubation and obstructive sleep apnoea. Br J Anaesth 1998; 80 (5) 606-611
    CrossrefPubMedGoogle Scholar
  • 24 Pilkington S, Carli F, Dakin MJ , et al. Increase in Mallampati score during pregnancy. Br J Anaesth 1995; 74 (6) 638-642
    CrossrefPubMedGoogle Scholar
  • 25 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 (1) 67-70
    CrossrefPubMedGoogle Scholar