The obstetric airway: failed intubation and the difficult airway in pregnancy

Your progress

Saved on this device.

Target exams

Red flags

• A parturient with a syndromic or anticipated difficult airway (e.g. Klippel-Feil, rheumatoid arthritis, previous difficult intubation, or severe pre-eclampsia with facial oedema) must be identified antenatally and managed with an awake technique where possible.
• Mallampati class worsens during labour and at term — reassess on the table before inducing, because the airway that was easy in clinic may now be difficult.
• Morbid obesity, an urgent indication, and an inexperienced operator together mark the highest-risk obstetric general anaesthetic; summon senior help before induction.
• The obstetric patient desaturates rapidly during apnoea — thorough preoxygenation with nasal oxygen and mask ventilation after induction, plus a head-up ramped position, are mandatory.
• Repeated laryngoscopy attempts worsen oedema and bleeding in the engorged obstetric airway; cap attempts and move to the supraglottic-airway rescue without delay.
• If cannot-intubate-cannot-oxygenate arises in a healthy mother without an immediately deliverable baby, the default is to wake her up; proceeding to front-of-neck access is reserved for the mother who cannot be oxygenated.