{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T05:08:44Z","timestamp":1789016924899,"version":"build-2803163510"},"reference-count":18,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Polyhydramnios is associated with adverse perinatal outcomes and is commonly assessed using either the amniotic fluid index (AFI) or the maximal vertical pocket (MVP). Although both methods are accepted in clinical practice, they frequently classify the same pregnancy differently, and their relative ability to predict adverse neonatal outcomes remains uncertain. Methods: We conducted a retrospective cohort study of pregnancies delivered at a tertiary university medical center between 2010 and 2025. Pregnancies with an AFI or MVP measurement within two weeks before delivery were eligible. Pregnancies complicated by diabetes mellitus or major fetal anomalies were excluded. Polyhydramnios severity was classified separately according to AFI and MVP criteria. The primary outcome was a composite of severe neonatal morbidity including neonatal intensive care unit admission, umbilical artery pH &lt; 7.1, 5 min Apgar score &lt; 7, or perinatal death. Separate multivariable logistic regression models were constructed for AFI- and MVP-based severity classifications. Results: Among 32,928 pregnancies, 3146 (9.6%) had polyhydramnios. Moderate-to-severe polyhydramnios defined by MVP was independently associated with severe neonatal morbidity (adjusted odds ratio [aOR] 2.47, 95% confidence interval [CI] 1.57\u20133.90; p &lt; 0.001), whereas AFI-based severity classification was not (aOR 1.44, 95% CI 0.98\u20132.12; p = 0.07). Severe neonatal morbidity increased progressively with increasing MVP measurements. Mild polyhydramnios, regardless of the measurement method, was not associated with increased neonatal morbidity. Similar findings were observed in sensitivity analyses. Conclusions: MVP-based severity classification identified pregnancies at increased risk of severe neonatal morbidity, whereas AFI-based classification did not, at their conventional thresholds. These findings suggest that MVP may provide better risk stratification in pregnancies complicated by polyhydramnios and support prospective studies to validate its role in clinical management.<\/jats:p>","DOI":"10.3390\/jcm15176932","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T16:30:02Z","timestamp":1788798602000},"page":"6932","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Maximal Vertical Pocket Better Identifies Pregnancies with Polyhydramnios at Increased Risk of Severe Neonatal Morbidity than the Amniotic Fluid Index: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Efrat","family":"Shekel","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hadassah University Medical Center, Ein Karem Campus, Jerusalem 9112001, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7900-6985","authenticated-orcid":false,"given":"Gali","family":"Gordon","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hadassah University Medical Center, Ein Karem Campus, Jerusalem 9112001, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1277-0021","authenticated-orcid":false,"given":"Nir","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hadassah University Medical Center, Ein Karem Campus, Jerusalem 9112001, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dina","family":"Weinstein Mezan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hadassah University Medical Center, Ein Karem Campus, Jerusalem 9112001, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7370-0417","authenticated-orcid":false,"given":"Michal","family":"Lipschuetz","sequence":"additional","affiliation":[{"name":"Henrietta Szold School of Nursing, Faculty of Medicine, Hebrew University, Jerusalem 9112102, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6527-7866","authenticated-orcid":false,"given":"Doron","family":"Kabiri","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hadassah University Medical Center, Ein Karem Campus, Jerusalem 9112001, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1055\/s-0033-1360163","article-title":"Polyhydramnios: Causes, diagnosis and therapy","volume":"73","author":"Hamza","year":"2013","journal-title":"Geburtshilfe Und Frauenheilkd."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Vanda, R., Bazrafkan, M., Rouhani, M., and Bazarganipour, F. (2022). Comparing pregnancy, childbirth, and neonatal outcomes in women with idiopathic polyhydramnios: A prospective cohort study. BMC Pregnancy Childbirth, 22.","DOI":"10.1186\/s12884-022-04625-y"},{"key":"ref_3","first-page":"57","article-title":"Polyhydramnios as a predictor of adverse pregnancy outcomes","volume":"13","author":"Tashfeen","year":"2013","journal-title":"Sultan Qaboos Univ. Med. J."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Bakhsh, H., Alenizy, H., Alenazi, S., Alnasser, S., Alanazi, N., Alsowinea, M., Alharbi, L., and Alfaifi, B. (2021). Amniotic fluid disorders and the effects on prenatal outcome: A retrospective cohort study. BMC Pregnancy Childbirth, 21.","DOI":"10.1186\/s12884-021-03549-3"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1111\/j.1471-0528.1990.tb02499.x","article-title":"Polyhydramnios and associated maternal and fetal complications in singleton pregnancies","volume":"97","author":"Desmedt","year":"1990","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/0029-7844(95)00179-U","article-title":"The association between polyhydramnios and preterm delivery","volume":"86","author":"Many","year":"1995","journal-title":"Obstet. Gynecol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1002\/uog.24973","article-title":"Idiopathic polyhydramnios and pregnancy outcome: Systematic review and meta-analysis","volume":"61","author":"Pagan","year":"2023","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Bas Lando, M., Urman, M., Weiss, Y., Srebnik, N., Grisaru-Granovsky, S., Farkash, R., and Sela, H.Y. (2023). Term idiopathic polyhydramnios, and labor complications. J. Clin. Med., 12.","DOI":"10.3390\/jcm12030981"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1111\/ajo.12578","article-title":"Outcome of pregnancy in women diagnosed with idiopathic polyhydramnios","volume":"57","author":"Khan","year":"2017","journal-title":"Aust. N. Z. J. Obstet. Gynaecol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1827","DOI":"10.1055\/s-0041-1739435","article-title":"Idiopathic polyhydramnios and neonatal morbidity at term","volume":"40","author":"Polnaszek","year":"2023","journal-title":"Am. J. Perinatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"5296","DOI":"10.1038\/s41598-024-54840-0","article-title":"Obstetric and neonatal outcomes in pregnant women with idiopathic polyhydramnios: A systematic review and meta-analysis","volume":"14","author":"Kechagias","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Society for Maternal-Fetal Medicine (SMFM), Dashe, J.S., Pressman, E.K., and Hibbard, J.U. (2018). SMFM Consult Series #46: Evaluation and management of polyhydramnios. Am. J. Obstet. Gynecol., 219, B2\u2013B8.","DOI":"10.1016\/j.ajog.2018.07.016"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1002\/uog.10093","article-title":"Maximal amniotic fluid index as a prognostic factor in pregnancies complicated by polyhydramnios","volume":"39","author":"Khalek","year":"2012","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1111\/1471-0528.12589","article-title":"Association and prediction of amniotic fluid measurements for adverse pregnancy outcome: Systematic review and meta-analysis","volume":"121","author":"Morris","year":"2014","journal-title":"BJOG"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1002\/uog.14924","article-title":"Single deepest vertical pocket or amniotic fluid index as evaluation test for predicting adverse pregnancy outcome (SAFE trial): A multicenter, open-label, randomized controlled trial","volume":"47","author":"Kehl","year":"2016","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1177\/8756479316687269","article-title":"Amniotic fluid assessment: Amniotic fluid index versus maximum vertical pocket","volume":"33","year":"2017","journal-title":"J. Diagn. Med. Sonogr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1002\/jum.15116","article-title":"Accuracy of the ultrasound estimate of the amniotic fluid volume (amniotic fluid index and single deepest pocket) to identify actual low, normal, and high amniotic fluid volumes as determined by quantile regression","volume":"39","author":"Hughes","year":"2020","journal-title":"J. Ultrasound Med."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Pasquini, L., Ponziani, I., Pallottini, M., Masini, G., Seravalli, V., Dani, C., and Di Tommaso, M. (2022). Obstetric and neonatal outcomes in mild idiopathic polyhydramnios. Children, 9.","DOI":"10.3390\/children9111624"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6932\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T04:30:16Z","timestamp":1789014616000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6932"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,7]]},"references-count":18,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15176932"],"URL":"https:\/\/doi.org\/10.3390\/jcm15176932","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,7]]}}}