The value of ultrasound estimates of oligohydramnios in predicting adverse neonatal outcomes is debatable. Our objective was to review available literature on methods of assessment of amniotic fluid and their association with perinatal outcomes. We also sought to determine whether incorporating horizontal measurements in the assessment of the amniotic fluid index (AFI) improves its performance in identifying pregnancies at risk of adverse outcomes. Review of literature and retrospective review of patient's charts was performed. We retrieved an ultrasound database of the stored images of the four quadrants used in the calculation of the last AFI, and measured the largest width of each pocket. We evaluated three methods for assessment of amniotic fluid and charts were reviewed for the composite primary neonatal outcome. Receiver operating characteristics (ROC) curves were used for analysis (significance: P<0.05). We concluded that the evidence of the ability of isolated oligohydramnios, to predict adverse neonatal outcomes is controversial. Evidence is emerging in favor of a single Deepest Vertical Pocket (DVP) for evaluating the amniotic fluid, as it is associated with lower false positive rates. In our data analysis, we found that incorporating horizontal measurements in the measurement of AFI does not improve its performance.