Systematic review of the clinical prediction rules for the calculation of the risk of Down syndrome based on ultrasound findings in the second trimester of pregnancy


  • Funding sources: This work is partially supported by grants from the Fundación de Investigación Sanitaria de Castilla La Mancha (FISCAM). Ref: PI-2010/052.

  • Conflicts of interest: None declared



The objective of this article is to systematically review the various published clinical prediction rules used to calculate the risk of Down syndrome (DS) after carrying out an ultrasound in the second trimester of pregnancy.


A systematic search in the main bibliographic databases was carried out. Three independent observers identified the odds ratios and regression coefficients that allowed for the estimation of the risk of DS after ultrasound screening. Four of the clinical prediction rules were integrated into a computer application (ecodown 2.0®).


A total of ten clinical prediction rules were found. Three had been validated, two internally and one externally. We empirically checked the accuracy of the clinical prediction rule estimates obtained from 2216 ultrasound scans performed at our hospital. The application of the clinical prediction rules elaborated by Nicolaides and Zhong to the 2216 ultrasound scans showed a low concordance.


Clinical prediction rules allow for the integration of second-trimester ultrasound findings to calculate the risk of DS. However, results from the different clinical prediction rules are not concordant and may generate situations of overestimation or underestimation of the risk of DS. It is thus necessary to validate these clinical prediction rules externally to decide which is most suitable for clinical use. © 2014 John Wiley & Sons, Ltd.