A 48-year-old woman with a BMI of 38 kg/m² and a history of obstructive sleep apnea presents for pre-anesthetic evaluation before bariatric surgery. During airway assessment, when she opens her mouth maximally and protrudes her tongue, the examiner can see only the soft palate and the base of the uvula; the tonsillar pillars and fauces are not visible. She also has a thyromental distance of 6 cm and can touch her chin to her chest. What is her Mallampati score, and what is the primary clinical implication?