Ultrasonographical Assessment of Airway Indices in Pregnancy

Clinical and Ultrasonographic Assessment of Airway Indices Among Nonpregnant, Normotensive Pregnant and Pre-eclamptic Patients: a Prospective Observational Study

Clinical and ultrasound indices of airway, in addition to laryngoscopic view will be assessed and compared among three groups of patients: non pregnant, pregnant with normal blood pressure, preeclampsia patients undergoing various surgeries under general anesthesia.

Study Overview

• Status: Recruiting
• Conditions: Airway Assessment

Detailed Description

Tracheal intubation (TI) through direct laryngoscopy is often performed in patients to establish an airway to provide adequate ventilation and oxygenation, and/or to protect the airway from aspiration of oral and pharyngeal secretions. Difficult intubation occurs due to insufficient vision of the larynx during direct laryngoscopy. Some constraints such as full stomach and aspiration risk, unknown past medical and allergy history may make the actual number of difficult intubation in operating room. It seems that, to prevent complications due to repeated attempt for intubation (arrythmia, hypoxia, …), early detection of probable difficult laryngoscopy cases is of great importance in the operating room. Therefore, various screening methods and scales have been defined in this regard . Cormack-Lehane classification and Mallampati are among screening methods that is used to predict difficult airway and laryngoscopy cases; However, all have considerable limitations . Therefore, the search for a simple, non-invasive technique that provides a more accurate assessment of the patient's airway still continues. The ideal method is expected to be fast, accessible, simple and non-invasive .Today, portable ultrasound devices are widely available in OR and recently studies have focused on its capabilities in terms of airway management . At present, airway ultrasonography is not yet used as a common method for airway assessment. Although several parameters of airway ultrasound have been mentioned in various studies as difficult airway prediction indicators, research is still ongoing to obtain easy and accurate measures . Therefore, this study performed to investigate the relationship between some upper airway ultrasound assessment parameters with difficult laryngoscopy / difficult intubation in pregnant and preeclamptic females and aim to use these parameters to assist physician to decide about difficult laryngoscopy/ difficult intubation and consider as predictors beside the traditional methods.

The first step in airway management is the assessment of various airway indices. Various anatomical and physiological factors place pregnant females at greater risk of airway management complications and difficult intubation. Hypertensive conditions of pregnancy are associated with aggravated changes in the airway, including a narrower upper airway compared with healthy pregnant females. In routine clinical practice, quick and easy bedside assessments are performed pre-operatively to evaluate the airway. These methods have high interobserver variability and only fair to moderate sensitivity and specificity. The role of ultrasound in airway assessment is encouraging as anatomical structures can be visualised in supraglottic, glottis and subglottic views. With the development of better probes, high resolution imaging, real-time pictures and clinical experience, In this prospective study, we assessed the airway indices of non-pregnant, normotensive pregnant and preeclamptic pregnant females using both clinical parameters and ultrasonographic assessment.

• Study Type: Observational
• Enrollment (Estimated): 180

Contacts and Locations

• Study Contact: Name: Zeinab M Sayed, MD; Phone Number: +02 01009071365; Email: zeinab5aton@gmail.com

Study Locations

• Egypt
  • Qena Governorate
    • Qina, Qena Governorate, Egypt, 83511
      • Recruiting
      • Qena University
      • Contact: ZAINAB MOSTAFA; Phone Number: 01009071365; Email: zeinab5aton@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

non pregnant, normotensive pregnant and preeclamptic patients who are undergoing general anesthesia, and also apply to the inclusion criteria and have non of the exclusion criteria mentioned above.

Description

Inclusion Criteria:

• -normotensive pregnant
• pre-eclamptic patients.
• nonpregnant females in child bearing period .

Exclusion Criteria:

• Patients excluded were women at <32 weeks' gestation or with Eclampsia .
• height <150 cm, body mass index (BMI) >30 kg/m2 .
• predicted airwy difficulty due to any other cause as neck swelling , facial deformity and prominent teeth.

Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort
Non Pregnant; non pregnant patients undergoing surgery under general anesthesia
pregnant normotensive; pregnant normotensive patients undergoing surgery under general anesthesia
preeclampsia; preeclampsia patients undergoing surgery under general anesthesia

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Sperficial ultrasonographic airway assessemt	By using superficial ultrasound probe, we measure in millimeters: anterior neck skin to hyoid bone distance, anterior neck skin to vocal cord distance (ANS-VC) ,distance from the epiglottis to the midpoint of the distance between the vocal cords (E-VC),the depth of pre-epiglottic space (Pre-E) and Pre-E/E-VC ratio). All parameters will be measured in millimeters in all groups by the same doctor, and the same ultrasound device.	preoperative just before induction of anesthesia

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Assessment of laryngoscopic view	In all groups, we assess laryngoscopic view of airway using Cormack-Lehane classification system. Grade 1: Full view of the glottis (entire vocal cords and anterior commissure visible); intubation is straightforward. Grade 2: Partial glottic view; subdivided into 2a (posterior vocal cords visible) and 2b (only arytenoids seen); intubation often possible with manipulation. Grade 3: Only epiglottis visible, no glottis; intubation typically requires advanced techniques. Grade 4: Epiglottis not visible; predicts failed intubation, needing alternatives.	preoperative just before endotracheal intubation
Tongue thickness	By using deep ultrasound probe, we measure tongue thickness	Once just before induction of general anesthesia
Hyoid bone visibility	By using deep ultrasound probe, we measure hyoid bone visibility(HBV)	Preoperative just before induction of anesthesia

Collaborators and Investigators

• Sponsor: South Valley University

Study record dates

Study Major Dates

• Study Start (Actual): December 15, 2024
• Primary Completion (Estimated): November 1, 2026
• Study Completion (Estimated): December 1, 2026

Study Registration Dates

• First Submitted: November 25, 2025
• First Submitted That Met QC Criteria: February 17, 2026
• First Posted (Actual): February 20, 2026

Study Record Updates

• Last Update Posted (Actual): February 20, 2026
• Last Update Submitted That Met QC Criteria: February 17, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: airway, ultrasound, preeclampsia
• Additional Relevant MeSH Terms: Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Pregnancy Complications; Hypertension, Pregnancy-Induced; Pre-Eclampsia
• Other Study ID Numbers: ِAIP028-3

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No