Performance of Common Down Syndrome Screening Methods Used in India with Construction of an Indian Normogram for Nuchal Translucency/Crown–Rump Length Measurements in 14,337 Subjects


Background/Purpose of Study

Sonologists often lack access to the Fetal Medicine Foundation Down syndrome risk calculation software or cannot offer the combined test for aneuploidy screening because of resource constraints. Instead, sonologists use nuchal translucency (NT) measurements that rely on fixed NT cut-offs for labelling foetuses with high risks for Down syndrome. In the present study, we aimed to plot normative data for NT and the crown–rump length (CRL) in Indian foetuses and to assess the value of using the 95th/99th centiles of NT for CRL cut-offs instead of fixed NT cut-offs to calculate the risk for aneuploidies during the first trimester.


We conducted a retrospective observational study measuring the NT/CRL in 14,337 Indian foetuses between 11 and 13 + 6 weeks of gestation. We used regression analysis and calculated the 95th/99th centiles of NT distribution. We compared performances of NT > 95th/99th centiles and fixed NT cut-offs of 2.5- and 3.5-mm  as screening.


The NT measurements increased with increasing CRL values. NT > 95th centile for a particular CRL for detecting all aneuploidies had the maximum sensitivity of 73.9% for a false positive rate (FPR) of 4.3%. Similar values for fixed cut-off > 2.5 mm were 63.0% FPR 3.7% (T21 68.2 FPR 3.8%) and for NT > 3.5 mm 36.9% FPR 0.43% (T21 36.5% FPR 0.5%)


A fixed NT cut-off point is not appropriate for the first trimester screening. The best sensitivity for assessing aneuploidies is achieved using the 95th centile, but the 99th centile achieves higher specificity for gestational age.

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We are grateful to all the fellows and consultant colleagues at both Delhi and Bangalore centres who helped with scanning the patients.

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Correspondence to Anita Kaul.

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Anita Kaul and Prathima Radhakrishnan declare that they have no conflict of interest.

Human and Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the 1975 Declaration of Helsinki, as revised in 2008.

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Informed consent was obtained from all patients for being included in the study.

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This study has been approved by the Institutional Ethical Committee.

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Dr. Anita Kaul MS, FRCOG, FICOG, Dip Fetal Medicine (FMF-UK) is a HOD of Apollo Centre For Fetal Medicine, Indraprastha Apollo Hospitals, New Delhi, India. Prathima Radhakrishnan FRCOG, Dip Fetal Medicine (FMF-UK) is a Director of Bangalore Fetal Medicine Centre, Bangalore, India.

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NT/CRL Normogram (DOCX 11 kb)

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Kaul, A., Radhakrishnan, P. Performance of Common Down Syndrome Screening Methods Used in India with Construction of an Indian Normogram for Nuchal Translucency/Crown–Rump Length Measurements in 14,337 Subjects. J Obstet Gynecol India 69, 142–146 (2019).

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  • Down syndrome
  • Antenatal screening
  • Nuchal translucency
  • Combined first trimester screening
  • NT normogram