THE METRIC OF EFFICIENCY: WHY SWITCHING TO SINGLE DEEPEST POCKET IS AN IMPERATIVE FOR LOW-RESOURCE OBSTETRICS

Abstract

Amniotic fluid volume measurement is a critical component of antepartum surveillance, acting as an essential proxy for fetal renal perfusion and placental health. For decades, obstetrical ultrasound has been based on the Amniotic Fluid Index (AFI), which is the sum of vertical pockets in four quadrants. However, in Low- and Middle-Income Countries (LMICs), therapeutic dogma must survive resource efficiency scrutiny. Emerging data and shifting international recommendations indicate that AFI's "more is better" strategy may contribute to a cascade of unneeded interventions.This editorial contends that the Single Deepest Pocket (SDP) approach is more than just a "pragmatic alternative" in low-resource situations; it is the preferable clinical standard. By minimising oligohydramnios overdiagnosis, SDP saves surgical capacity for actual emergencies, making it an important tool for health equity.