Introduction /Context: High incidence of difficult or failed intubation in pregnant patients is still a major challenge for anaesthesiologists. To evaluate airway changes in pregnant patients we used mallampatti grade and image J software at various intervals. 

Aims: To assess the upper airway changes in pregnant women at the onset of labour, following delivery and after 48 hours and to identify any predictive factors. 

Settings and Design: Methods and Material: 77 ASA II parturients admitted to the labour and delivery suite (early active labour, cervical dilatation 2-3 cm) were included in the study. Initial airway examination was graded according to the Samsoon modiûcation of the Mallampatti classiûcation(T1).Airway photographs were taken. The images were studied under Image J software and the area of opening of the oropharynx were calculated. 

Statistical analysis used: Mc Nemar Bowkar test, Wilcoxan signed ranks test and chi-square test. Results: Significant differences were seen in percentage of parturients in whom mallampatti grading changed more than 1, equal to 1 or more grade at T1-T2 (24.6%, P<0.05) T2-T3 (37.6%, P=0.036) T1-T3 (55.8%, P=0.00008). Mean area of opening of oropharynx with MPG grade 3 or less than 3 at T1 (59.38%) T2 (64.5%) T3 (80%). Significant changes were also seen in mean area change in parturients with MPG 3 or less than 3 at T2-T3 (29.5%) T3-T2 (37.75%) T3-T1 (54.04%). 

Conclusions: There is significant change in the airway of pregnant women undergoing labour and delivery and these changes are fully reversed by 48 hours after delivery. Our study conûrms the absolute necessity of examining the airway before anaesthetic management in obstetric patients