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To assess the quality of nuchal translucency (NT) measurements in primary care and the sonologist’s characteristics related with a higher quality.The median NT expressed in multiples of the median (MoM) was calculated for each sonologist of 14 participating antenatal primary care centers of the Catalan Institute of Health. A survey to the sonologists was used to establish variables related to higher-quality measurements.The median NT MoM obtained in 16 448 NT measurements, performed by 102 sonologists, was 0.94 MoM. NT underestimation was observed in 46% of the sonologists. Underestimation were less frequent among professionals who performed more than 230 ultrasounds per year (26% vs 53%;p = .022), those who completed the online Fetal Medicine Foundation (FMF) course (22% vs 54%; p = .021), and those who were subject to periodic audits (24% vs 56%; p = .021). Underestimation rate decreased from 60%, to 33% and 14% with the increase of the years of experience from less than 5 years, to 6 to 15 years and more than 15 years of experience, respectively (p = .029).Higher-quality measurements were demonstrated in sonologists who performed more ultrasounds per year, those with more years of scanning experience, those who completed the online FMF course, and those periodically audited.What’s already known about this topic?Underestimation of the nuchal translucency (NT) measurement has already been widely described by various authors.The effectiveness of the first-trimester combined screening depends on the ability to obtain optimal NT measurements.The identification of factors associated with a better performance can be used to improve NT measurements.What does this study add?This study describes the performance of NT measurement in primary antenatal care centers, in contrast with tertiary center studies.This study identifies some factors associated with high-quality measurements in order to establish corrective actions: (a) a minimum number of ultrasounds per sonologist and year; (b) completion and certification of the FMF online course; and (c) establishment of an NT quality monitoring system, in which sonologists receive their results and guidance.