ABORTION FOR TRISOMY 21 GEETA SHARMA, HEATHER T. GOLD, STEPHEN T. CHASEN, ABIGAIL K. ALT, LAURENCE MCCULLOUGH, FRANK A. CHERVENAK, Columbia University, Obstetrics and Gynecology, New York, New York, Weill Medical College of Cornell University, Public Health, New York, New York, Weill Medical College of Cornell University, Obstetrics and Gynecology, New York, New York, Baylor College of Medicine, Medicine, Houston, Texas, Cornell University Medical Center, Obstetrics/Gynecology, New York, New York OBJECTIVE: The decision to undergo abortion may be related to one’s medical or personal history. We sought to understand demographic factors that contribute to a patient’s hypothetical decision to undergo an abortion for Down Syndrome (DS). STUDY DESIGN: First trimester ultrasound patients with singleton gestations were prospectively recruited to complete an anonymous, voluntary survey regarding first trimester screening. Personal demographic and pregnancy history information was obtained and quantified. A 5-point Likert scale was used to assess patients’ preferences regarding pregnancy termination if a diagnostic test revealed DS. Chi-square and Mann-Whitney U tests were used for statistical analysis. Patients were recruited by a physician not involved in their care. RESULTS: There were 102 women who completed the survey. The median age was 33 years, and 40 patients were primigravid. Of the multigravidas, 20.6% had a history of voluntary abortion (VTOP) and 22.5% had had a spontaneous abortion. Factors such as maternal age, education level, employment status, infertility, knowledge of someone with DS and intact support systems were not significantly associated with patient preferences to have or not have an abortion. However, multigravidas with a history of VTOP were significantly more likely to prefer having another VTOP if test results showed DS (57.1% vs 25.6%, P = .016). CONCLUSION: There were no reliable factors that predicted a woman’s decision to undergo termination of pregnancy for Down Syndrome, except multigravidas with a history of VTOP were significantly more likely to choose to undergo an abortion. 600 RANDOMIZED DOUBLE BLIND COMPARISON OF REMIFENTANIL AND DIAZEPAM FOR FETAL IMMOBILIZATION AND MATERNAL SEDATION DURING FETOSCOPIC SURGERY JAN DEPREST, DOMINIQUE VAN SCHOUBROECK, LIESBETH LEWI, MARCO MARCUS, JACQUES JANI, CARLO MISSANT, ROLAND DEVLIEGER, AN TEUNKENS, MARC VANDEVELDE, University Hospital Gasthuisberg, Obstetrics and Gynecology, Leuven, Belgium, AZ Maastricht, Anesthesia, Maastricht, Netherlands, University Hospital Gasthuisberg, Anesthesia, Leuven, Belgium OBJECTIVE: Most fetoscopies are performed under (loco)regional anesthesia, which does not provide fetal immobilization. Transplacental administration of sedatives may achieve this and comfort the mother. Diazepam (DZP) induces profound maternal sedation and incomplete fetal immobilization. We compared the efficacy of I.V. remifentanil (REMI), a short acting opioid (umbilical vein/ maternal artery ratio 0.88) to that of DZP for maternal sedation and fetal immobilization. STUDY DESIGN: Single center randomized double blind trial with 54 consecutive women undergoing fetoscopic cord occlusion (n = 12) or laser surgery for TTTS (n = 42). Following CSE-anesthesia, incremental doses DZP (bolus 5 mg, 5 mg 10 min later and 2.5 mg top ups) or continuous infusion REMI (0.1 mg/kg/min followed by 0.025 bolus top ups). Patients, gynecologists and attending anesthesiologist were blinded to the sedative used. Maternal sedation (observer alertness score-OAS, need for additional medication), hemodynamics, side-effects as well as fetal hemodynamics and immobilization (Visual Analog Score by ultrasonographer and surgeon, later review of videotape by third assessor) were evaluated prior, during and for 60 min after surgery. Statistics were by ANOVA testing, and chi-square Fisher exact test for categorical data. Data are presented as mean G Standard Deviation, median and interquartile range and percentage of group total. RESULTS: Four fetuses were excluded because of absence of fetal movements at baseline. DZP (mean = 14.5 G 4.8 mg) resulted in deeper maternal sedation without respiratory depression. REMI (0.115 G 0.020 mg/kg/min) produced adequate maternal sedation with mild but clinically irrelevant respiratory depression, except in one patient with OAS !4. Fetal immobilizatin occurred faster and was better but on stimulation the fetus was easily awakened. This resulted in more often good surgical conditions (32 % DZP, 92 % REMI), shorter operation times and mothers being less sedated afterwards. Similar doses and number of top ups of ephedrine and phenylephrine were required in both groups. CONCLUSION: REMI provides excellent fetal immobilization and maternal sedation and is immediately reversible. This method of transplacental sedation could also be applied during other fetal procedures without direct fetal pain stimulus (eg MRI).