The Evidence for Abandoning the Amniotic Fluid Index in Favor of the Single Deepest Pocket
Abstract
This study assessed whether the amniotic fluid index (AFI) or the single deepest pocket (SDP) is the best technique to estimate amniotic fluid volume. The AFI and SDP were compared to a dye-determined or directly measured amniotic fluid volume. A PUBMED search from 1990 to 2006 was conducted using the search terms "single deepest pocket" or "largest vertical pocket" or "maximum vertical pocket" or "2X1 pocket" AND "amniotic fluid index". One study compared the AFI and SDP to a dye-determined amniotic fluid volume. There were 1219 publications that used the search term SDP-LVP-MVP versus 4378 using AFI. Twenty publications contained both the AFI and SDP, but only six compared the AFI and SDP. Both the AFI and the SDP poorly identified abnormal amniotic fluid volumes, and neither technique was superior to the other. The AFI identifies a significantly greater number of women as having oligohydramnios versus the SDP but without any difference in perinatal outcomes. Compared with SDP, AFI excessively characterizes a greater number of pregnancies as having oligohydramnios leading to more interventions without improvement in perinatal outcome. The AFI should be abandoned and the SDP used to estimate amniotic fluid volume.
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Amniotic fluid index identifies more women as having oligohydramnios than does deepest vertical pocket, thereby increasing the rate of labor induction, but without improving clinical outcome.
“However, it appears that AFI identifies more women as having oligohydramnios than does DVP, thereby increasing the rate of labor induction, but without improving the clinical outcome 37,38 .”
From <scp>ISUOG</scp> Practice Guidelines (updated): performance of the routine mid‐trimester fetal ultrasound scan (2022) · cites this paper as [37]
Both amniotic fluid index and deepest vertical pocket correlate poorly with the actual dye-calculated volume of amniotic fluid, and neither appears significantly better than the other.
“Both AFI and DVP correlate poorly with the actual dye-calculated volume of amniotic fluid, and neither of them appears significantly better than the other 37 .”
From <scp>ISUOG</scp> Practice Guidelines (updated): performance of the routine mid‐trimester fetal ultrasound scan (2022) · cites this paper as [37]
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- Authors
- Magann, E., Chauhan, S., Doherty, D., Magann, M., & Morrison, J.
- Affiliations
- Naval Medical Center Portsmouth (US)
- Aurora Health Care (US)
- The University of Western Australia (AU)
- University of Mississippi Medical Center (US)
- Venue
- American Journal of Perinatology
- Publisher
- Georg Thieme Verlag KG
- Published
- 2007-09
- Volume
- 24
- Issue
- 9
- Pages
- 549-555
- ISSN
- 0735-1631 (ISSN-L)
- 1098-8785
- OpenAlex
- W2072462568
- Cited by
- 65
- References
- 16
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 4 · 2023: 3 · 2022: 2 · 2021: 2 · 2020: 2 · 2019: 5 · 2018: 3 · 2017: 4 · 2016: 2 · 2015: 3 · 2014: 3 · 2013: 4 · 2012: 4
- FWCI
- 4.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Perinatology (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Screening and Diagnostics
- Health Sciences › Medicine › Epidemiology › Preterm Birth and Chorioamnionitis
- Keywords
- amniotic fluid index, oligohydramnios, polyhydramnios, prenatal ultrasound, perinatal outcomes, diagnostic accuracy
- MeSH terms
- Amniotic Fluid, Female, Humans, Predictive Value of Tests, Pregnancy, Pregnancy Outcome, Oligohydramnios, Ultrasonography, Prenatal
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