Formation of a National Perinatal Nitrous Oxide Data Registry: The Intrapartum Nitrous Oxide Workgroup I-NOW

Barbara Orlando,Deborah Stein,Jessica Anderson,Cristina Wood

doi:10.29024/jsim.129

Abstract

Background: There are a variety of labor analgesic options for parturients, such as intravenous opioids, neuraxial interventions, hydrotherapy, hypnosis, as well as inhaled nitrous oxide (N2O). Inhaled N2O has been utilized outside of the United States (U.S.) for decades but has only recently gained popularity in the U.S. as a labor analgesic. There are no current multi-center data registries evaluating N2O use as a labor analgesic regarding conversion rates, side effects, and delivery outcomes. Methods: We created the first multi-center N2O data registry to gather maternal and newborn outcome data from several institutions across the U.S. All centers were required to sign a Memorandum of Understanding (MOU) which stated that at least 80% of all parturients utilizing N2O for labor would be included in the database. We hypothesized that the data would assist in counseling and consenting parturients regarding incidence of side effects, conversion rates and etiologies, as well as neonatal outcomes. This manuscript demonstrates the steps taken to create the data registry, including institutional enrollment, development of a data collection tool, selection of the data management system and administrator, organization of multiple institutional review boards, delineation of responsibilities and challenges encountered with implementation. Conclusion: The development of a multi-center data registry was successfully created as we saw a need for a safe data-sharing system to answer mutually determined research questions, and to collect strong data information in order to provide evidenced based data to patients and providers.

Highlights

Journal of ScientificClose to four million women in the United States (US) give birth each year and for most of them pain control during labor is a major concern [1]
The available data suggests that N2O provides minimal analgesia to laboring women, it does help them cope with labor pain [6] and they are just as satisfied with N2O as they are with neuraxial analgesia [7]
In November 2014, the University of Colorado Hospital implemented N2O as a labor analgesic and initiated discussions with other institutions offering N2O in labor, which resulted in the creation of the Intrapartum Nitrous Oxide Workgroup (I-)

Summary

Introduction

Journal of ScientificClose to four million women in the US give birth each year and for most of them pain control during labor is a major concern [1]. The limited use of N2O for labor analgesia in the U.S is likely due to both an increase in popularity of neuraxial analgesia [3] and concerns for the safe delivery of N2O to the parturient and the staff caring for her. The available data suggests that N2O provides minimal analgesia to laboring women, it does help them cope with labor pain [6] and they are just as satisfied with N2O as they are with neuraxial analgesia [7]. There are a variety of labor analgesic options for parturients, such as intravenous opioids, neuraxial interventions, hydrotherapy, hypnosis, as well as inhaled nitrous oxide (N2O). There are no current multi-center data registries evaluating N2O use as a labor analgesic regarding conversion rates, side effects, and delivery outcomes

Methods

Results

Conclusion