Many different diagnostic strategies are available for predicting pregancies at high risk of Down Syndrome based on maternal age, ultrasound markers, serological tests and urine tests, some of which have been implemented in screening programmes.  The Cochrane Pregnancy and Childbirth Group has undertaken a pilot Cochrane Diagnostic Test Accuracy Review of the evidence of the diagnostic accuracy of these strategies.  The key stages of this review will be outlined, together with the challenges experienced and lessons learned. Preliminary findings will be presented.