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From ad hoc Down's syndrome screening to a functional uniform national screening programme

The implementation of a uniform service for Down's syndrome screening in England has been ongoing since it was first set out in 2001 that all women would be offered screening. The main aim has been to improve the detection rate while retaining a low screen positive rate (Spr) using a combined screening strategy. It has been a major challenge to ensure that the measurement of the nuchal translucency using ultrasound is performed well in each hospital and that sonographers are supported in meeting that challenge. The service is now beginning to meet the national policy that all units must offer combined screening and that it reaches a 90% detection rate for a 2% Spr.