Mallampati classification, an estimate of upper airway anatomical balance, can change rapidly during labor.

THE Mallampati classification is a rough estimate of the tongue size relative to the oral cavity. Although the single usage of the Mallampati classification has limited discriminative power for difficult tracheal intubation, it is a simple, reproducible, and reliable preanesthetic airway assessment method when performed properly. In addition to difficult tracheal intubation, Mallampati class 3 or 4 is an independent predictor for difficulty of mask ventilation during anesthesia induction and presence of obstructive sleep apnea. Increase of the Mallampati class during labor and delivery reported in this issue of ANESTHESIOLOGY provides insight for exploring and understanding the mechanisms of difficulty in perioperative airway management of pregnant women, particularly during or immediately after labor. In the article, the authors thoroughly discuss the clinical implications of their findings on difficult tracheal intubation; therefore, I would like to assess their data focusing on perioperative upper airway obstruction of pregnant women.