Perineal Lacerations: A Retrospective Study in a Habitual-Risk Public Maternity / Lacerações perineais: um estudo retrospectivo em uma maternidade pública de risco habitual

Abstract Objective In around 85% of vaginal births, the parturients undergo perineal lacerations and/or episiotomy. The present study aimed to determine the incidence of lacerations and episiotomies among parturients in 2018 in a habitual-risk public maternity hospital in southern Brazil, and to determine the risk and protective factors for such events. Methodology A retrospective cross-sectional study. Data were obtained from medical records and analyzed using the Stata software. Univariate and multivariate logistic regressions were performed. Values of p<0.05 were considered significant. Results In 2018, there were 525 vaginal births, 27.8% of which were attended by obstetricians, 70.7% by obstetric nurses, and 1.5% evolved without assistance. Overall, 55.2% of the parturients had some degree of laceration. The professional who attended the birth was a significant variable: a greater number of first- and second-degree lacerations, as well as more severe cases, occurred in births attended by nurses (odds ratio [OR]: 2,95; 95% confidence interval [95%CI]: 1,74 to 5,03). Positions at birth that did not enable perineal protection techniques (expulsive period with the "hands-off" method), when analyzed in isolation, determined the risk; however, in the final regression model, this relationship was not confirmed. Although reported in the literature, there were no associations between the occurrence of laceration and age, skin color, or birth weight. In 24% of the births, episiotomy was performed, and doctors performed 63.5% of them. Conclusion Births attended by nurses resulted in an increased risk of perineal lacerations, of varying degrees. In turn, those assisted by physicians had a higher occurrence of episiotomy.

Resumo Objetivo Aproximadamente 85% dos partos vaginais cursam ou com lacerações perineais e/ou com episiotomia. Este estudo objetivou determinar a incidência de lacerações e episiotomias das parturientes de 2018 de uma maternidade pública de risco habitual, no sul do Brasil, bem como determinar os fatores de risco e proteção para tais eventos. Métodos Estudo transversal retrospectivo, no qual os dados foram obtidos dos prontuários e analisados no programa Stata. Realizaram-se regressões logísticas uni e multivariada. Foram considerados como significantes valores de p<0,05. Resultados Em 2018, aconteceram 525 partos vaginais, sendo 27,8% assistidos por médicos obstetras, 70,7%, por enfermeiros obstetras, e 1,5% evoluíram sem assistência. Ao todo, 55,2% das parturientes apresentaram algum grau de laceração. O profissional que assistiu ao parto foi uma variável que demonstrou significância: um maior número de lacerações de primeiro e segundo graus, bem como casos de maior gravidade, ocorreram em partos assistidos por enfermeiros (razão de probabilidades [RP]: 2,95; intervalo de confiança de 95% [IC 95%]: 1,74 a 5,03). Posições ao nascimento que não permitiam técnicas de proteção perineal (período expulsivo na técnica "sem mãos" [hands off, em inglês]), quando analisadas isoladamente, determinaram o risco; contudo, no modelo final de regressão, essa relação não se confirmou. Apesar de relatada na literatura, não houve associação entre a ocorrência de laceração e a idade, a cor da pele, ou o peso de nascimento. Em 24% dos partos, uma episiotomia foi realizada, tendo os médicos executado 63,5% delas. Conclusão Partos assistidos por enfermeiros resultaram em um maior risco de lacerações perineais, de variados graus. Por sua vez, os assistidos por médicos apresentaram maior ocorrência de episiotomia.

Do we know How to avoid OASIs in non-Supine Birth Positions? a retrospective cohort analysis / Sabemos como evitar as LOEAs em posições de parto não supinas? Uma análise de coorte retrospectiva

Abstract Objective To evaluate the association between the upright and supine maternal positions for birth and the incidence of obstetric anal sphincter injuries (OASIs). Methods Retrospective cohort study analyzed the data of 1,728 pregnant women who vaginally delivered live single cephalic newborns with a birth weight of 2,500 g. Multiple regression analyses were used to investigate the effect of the supine and upright positions on the incidence of OASIs after adjusting for risk factors and obstetric interventions. Results In total, 239 (13.8%) births occurred in upright positions, and 1,489 (86.2%) in supine positions. Grade-III lacerations occurred in 43 (2.5%) patients, and grade-IV lacerations occurred in 3 (0.2%) women. Supine positions had a significant protective effect against severe lacerations, odds ratio [95% confidence interval]: 0,47 [0.22- 0.99], adjusted for the use of forceps 4.80 [2.15-10.70], nulliparity 2.86 [1.44-5.69], and birth weight 3.30 [1.56-7.00]. Anesthesia (p<0.070), oxytocin augmentation (p<0.228), shoulder dystocia (p<0.670), and episiotomy (p<0.559) were not associated with the incidence of severe lacerations. Conclusion Upright birth positions were not associated with a lower rate of perineal tears. The interpretation of the findings regarding these positions raised doubts about perineal protection that are still unanswered.

Resumo Objetivo Avaliar a associação entre as posições maternas verticais e supinas ao nascimento e a taxa de incidência de lesões obstétricas do esfíncter anal (LOEAs). Métodos Estudo coorte retrospectivo que analisou os dados de 1.728 gestantes que tiveram parto vaginal cefálico simples com peso ao nascer de 2.500 g. Análises de regressão múltipla foram usadas para investigar o efeito de posições supinas ou verticais sobre a taxa de incidência de LOEAs após o ajuste para fatores de risco e intervenções obstétricas. Resultados No total, 239 (13,8%) nascimentos ocorreram nas posições verticais, e 1,489 (86,2%), nas posições supinas. Lacerações graves de grau III ocorreram em 43 (2,5%) pacientes, e de grau IV, em 3 (0,2%) mulheres. As posições supinas tiveram um efeito protetor significativo contra lacerações graves, razão de probabilidades [Intervalo de Confiança de 95%]: 0,47 [0.22-0.99], ajustado para o uso de Fórceps 4.80 [2.15-10.70], nuliparidade 2.86 [1.44-5.69], e peso ao nascer 3.30 [1.56-7.00]. Anestesia (p<0.070), aumento de ocitocina (p<0.228), distocia de ombro (p<0.670), e episiotomia (p<0.559) não estiveram associados à incidência de laceração grave. Conclusão As posições de parto verticais não estiveram associadas a uma menor taxa de ruptura perineal. A interpretação dos achados referentes a essas posições levantou dúvidas sobre a proteção perineal que ainda aguardam respostas.

Prevalence of high-grade perineal tear during labor in Mexican adolescents / Prevalencia de desgarro de alto grado en parto de adolescentes mexicanas

Abstract Introduction: There is a high rate of deliveries in adolescents in Mexico. This age group is vulnerable to obstetric complications, including lacerations of the anal sphincter. Objective: To determine the prevalence of third and fourth degree perineal tears in adolescents during childbirth, and to evaluate risk factors in comparison with deliveries with lacerations of adult women. Methods: All obstetric care episodes were reviewed from a public tertiary hospital data in Monterrey, Mexico in 2014. Age, primiparity, delivery instrumentation, episiotomy, body mass index, product weight and tear´s degree were documented at the deliveries with tears of third and fourth degree. Results: The prevalence of third and fourth degree tears of 2.0% was found in the general population, being adolescents the most affected with 2.5%. The unadjusted odds ratio of high-grade tears in adolescent females at delivery, compared to adult females, was 1.36 (95% CI = 0.99-1.86, p= 0.05). No difference was found when comparing risk factors among high-grade tear deliveries in adolescents versus adults. Conclusions: A higher prevalence than previous reported for high grade tears during delivery was found. The data suggest adolescence as a risk factor for high-grade tears during delivery.

Resumen Introducción: En México hay una elevada tasa de partos en adolescentes. Este grupo es vulnerable para complicaciones obstétricas, entre ellas laceración del esfínter anal. Objetivo: Conocer la prevalencia de desgarros perineales de tercer y cuarto grado en adolescentes durante el parto y evaluar factores de riesgo en comparación con partos con laceración de mujeres adultas. Métodos: Se revisaron todas las atenciones obstétricas en un hospital publico de tercer nivel en Monterrey, Nuevo León, México en el año 2014. Se documentó edad, primiparidad, instrumentación del parto, realización de episiotomía, índice de masa corporal, peso del producto y grado del desgarro en los partos que presentaron desgarros de tercer y cuarto grado Resultados: Se encontró una prevalencia general de 2.0% de desgarros de tercer y cuarto grado y en adolescentes de 2.5%. La razón de momios sin ajustar de desgarros de alto grado en mujeres adolescentes en comparación con mujeres adultas fue de 1.36 (IC 95%= 0.99-1.86, p= 0.05). No se encontró diferencia al comparar factores de riesgo entre los partos con desgarro de alto grado en adolescentes contra adultas. Conclusiones: Se encontró una prevalencia mayor a lo reportado de desgarros de alto grado durante el parto. Los datos sugieren a la adolescencia como factor de riesgo para desgarros de alto grado.

Perineal trauma in a low-risk maternity with high prevalence of upright position during the second stage of labor / Trauma perineal em uma maternidade de baixo risco com alta prevalência de parto vertical durante o período expulsivo

Abstract Objective Perineal trauma is a negative outcome during labor, and until now it is unclear if the maternal position during the second stage of labormay influence the risk of acquiring severe perineal trauma. We have aimed to determine the prevalence of perineal trauma and its risk factors in a low-risk maternity with a high incidence of upright position during the second stage of labor. Methods A retrospective cohort study of 264 singleton pregnancies during labor was performed at a low-risk pregnancymaternity during a 6-month period. Perineal trauma was classified according to the Royal College of Obstetricians and Gynecologists (RCOG), and perineal integrity was divided into three categories: no tears; first/ second-degree tears + episiotomy; and third and fourth-degree tears. A multinomial analysis was performed to search for associated factors of perineal trauma. Results From a total of 264 women, there were 2 cases (0.75%) of severe perineal trauma, which occurred in nulliparous women younger than 25 years old. Approximately 46% (121) of the women had no tears, and 7.95% (21) performed mediolateral episiotomies. Perineal trauma was not associated with maternal position (p = 0.285), health professional (obstetricians or midwives; p = 0.231), newborns with 4 kilos or more (p = 0.672), and labor analgesia (p = 0.319). The multinomial analysis showed that white and nulliparous presented, respectively, 3.90 and 2.90 times more risk of presenting perineal tears. Conclusion The incidence of severe perineal trauma was low. The prevalence of upright position during the second stage of labor was 42%. White and nulliparous women were more prone to develop perineal tears.

Resumo Objetivo O trauma perineal é um desfecho negativo durante o parto, e é incerto, até omomento, se a posiçãomaternal durante o período expulsivo pode influenciar o risco de evoluir com trauma perineal severo. Nós objetivamos determinar a prevalência de trauma perineal e seus fatores de risco em uma maternidade de baixo risco com alta prevalência de posição vertical durante o período expulsivo. Métodos Um estudo de coorte retrospectivo de 264 gestações únicas durante o trabalho de parto foi realizado durante 6 meses consecutivos. O trauma perineal foi classificado de acordo com o Royal College of Obstetricianns and Gynecologists (RCOG). A integridade perineal foi dividida em três categorias: períneo íntegro; trauma perineal leve (primeiro e segundo graus + episiotomia); e trauma perineal severo (terceiro e quarto graus). Uma análise multinomial foi realizada para buscar variáveis associadas ao trauma perineal. Resultados De um total de 264 mulheres, houve 2 casos (0,75%)de trauma perineal severo m nulíparas com menos de 25 anos. Aproximadamente 46% (121) das mulheres não tiveram trauma perineal e 7,95% (21) realizaram episiotomias mediolaterais. Não houve correlação do trauma perineal com a posição de parto (p = 0,285), tipo de profissional que realizou o parto (p = 0,231), recém-nascidos com 4.000 gramas ou mais (p = 0,672), e presença de analgesia de parto (p = 0,319). Uma análise multinomial evidenciou que mulheres brancas e nulíparas apresentaram, respectivamente, um risco 3,90 e 2,90 vezes maior de apresentar trauma perineal. Conclusão A incidência de trauma perineal severo foi baixa. A prevalência de parto vertical durante o período expulsivo foi de 42%. Mulheres brancas e nulíparas foram mais suscetíveis a apresentar trauma perineal.

Perineal trauma after vaginal delivery in healthy pregnant women / Trauma perineal após parto vaginal em parturientes saudáveis

CONTEXT AND OBJECTIVE: Despite all the medical care provided during delivery labor, perineal injury is still prevalent and may lead to diverse pelvic floor disorders. The aim here was to investigate the prevalence of obstetric and anal sphincter injuries (OASIS) in healthy pregnant women after vaginal delivery. DESIGN AND SETTING: Cross-sectional study involving 3,034 patients with singletons in a secondary hospital for low-risk cases. METHODS: A standardized questionnaire was prepared and applied to medical files that had been completely filled out (classification of the Royal College of Obstetricians and Gynecologists, RCOG) in order to identify OASIS and analyze risk factors associated with mild and severe perineal lacerations. RESULTS: The women's mean age was 25 years; more than half (54.4%) were primiparae. Almost 38% of the participants had perineal lacerations; these were severe in 0.9% of the cases. Previous vaginal delivery (odds ratio, OR: 1.64 [1.33-2.04]) and forceps delivery (OR: 2.04 [1.39-2.97]) were risk factors associated with mild perineal injuries (1st and 2nd OASIS classifications). Only remaining standing for prolonged periods during professional activity (OR: 2.85 [1.34-6.09]) was associated with severe perineal injuries. CONCLUSION: The prevalence of severe perineal injuries was concordant with data in the literature. The variable of standing position was considered to be a risk factor for severe perineal injury and should be further investigated. .

CONTEXTO E OBJETIVOS: Apesar do cuidado médico executado durante o trabalho de parto, os traumas perineais ainda são prevalentes e podem levar a várias desordens do assoalho pélvico. O objetivo foi investigar a prevalência de injúrias obstétricas e do esfíncter anal em mulheres saudáveis após parto vaginal. DESENHO E LOCAL DE ESTUDO: Estudo transversal envolvendo 3.034 pacientes com recém-natos únicos de um hospital secundário de baixo risco. MÉTODOS: Um questionário padronizado foi preparado e aplicado aos prontuários completamente preenchidos (classificação do Royal College of Obstetricians and Gynecologists) para identificar as lesões obstétricas e do esfíncter anal e analisar fatores de risco associados com lacerações perineais leves e graves. RESULTADOS: A média de idade das mulheres era 25 anos; mais da metade (54,4%) era primípara. Quase 38% das participantes tiveram lacerações perineais; estas foram graves em 0,9% dos casos. A presença de parto vaginal prévio (odds ratio, OR, 1,64 [1,33-2,04]) e o parto fórceps (OR 2,04 [1,39-2,97]) foram fatores de risco associados às lesões perineais leves (primeira e segunda classificações de lesão esfíncter e anal). Somente a posição em pé prolongada durante a atividade profissional (OR 2,85 [1,34-6,09]) estava associada com lesões perineais graves. CONCLUSÃO: A prevalência de trauma perineal grave concordou com dados da literatura. A variável posição em pé foi considerada fator de risco para trauma perineal grave e necessita ser investigada. .

Clinical characteristics and causality of eye lid laceration in Iran

The aim of this study was to assess the etiological characteristics and visual outcomes of ocular trauma with more attention to eyelid laceration. In a cross-sectional study, 98 cases of isolated traumatic eyelid laceration were consecutively studied and its epidemiology, etiology and association with visual outcome were evaluated. The findings of this study could be used to develop healthcare related precautions and work place safety recommendations. Of the 98 patients included in the study, men exhibited a greater vulnerability and they were mostly aged around 29 years old. In terms of the place of trauma, 42 [42.8%] cases occurred in the street, 29 cases [29.6%] occurred at home, and 18 cases [18.4%] occurred at the workplace, while 5 cases [5.1%] happened in entertaining environments like parks. For 3 patients [3%], the incident took place at a public pathway, and in 1 patient [1%], the case occurred at school. As the most common cause of trauma, 41 patients [41.8%] had an object hit their eyes. In addition, assaults were a major cause of injury. The right eye and the upper lid were also the most common sites of injuries. Although no blindness occurred due to trauma causing eyelid laceration, the visual outcomes were correlated with severity of the incident defined based on the presence of open globe injuries. This study could possibly highlight the risk factors of eyelid laceration and provide the healthcare community with the essential recommendations regarding the safety precautions in dangerous settings, including daily/routine work places

Episiotomia, laceração e integridade perineal em partos normais: análise de fatores associados / Episiotomía, desgarro e integridad perineal en partos normales: análisis de factores asociados / Episiotomy, laceration and perineal integrity in spontaneous deliveries: analysis of factors associated

O estudo teve como objetivo associar a integridade perineal, laceração espontânea e episiotomia em partos normais com a idade materna, paridade, idade gestacional, peso e vitalidade do recém-nascido. Estudo retrospectivo realizado no Hospital Geral de Itapecerica da Serra, São Paulo, no período de novembro de 2000 a junho de 2002, com 6.365 partos ocorridos entre 1999 e 2001. Realizou-se análise descritiva e de regressão logística uni e multivariada e calculou-se o odds ratio condicional com intervalo de confiança de 95%. Os resultados mostraram que 25,9% das mulheres foram submetidas a episiotomia; 28,6% tiveram a integridade perineal preservada; 45,5% tiveram laceração espontânea. A chance de episiotomia aumenta com a nuliparidade (OR=3,0), prematuridade (OR=2,3) e Apgar<7 no primeiro minuto (OR=2,1), enquanto que a chance de laceração de segundo grau associa-se com peso do recém-nascido >3.300g (OR=1,6). Concluiu-se que o desfecho perineal associou-se com a paridade, prematuridade, peso e vitalidade do recém-nascido.

The aim was to associate perineal integrity, spontaneous laceration and episiotomy in spontaneous deliveries with maternal age, parity, and gestational age, weight and vitality of the newborn. A cross-sectional study was conducted at the Itapecerica da Serra General Hospital, Sao Paulo, from November to June 2002, with 6,365 births between 1999 and 2001. Descriptive analysis and univariate and multivariate logistic regression were conducted, and the conditional odds ratio was calculated with a 95% confidence interval. The results showed that 25.9% of women underwent episiotomy, in 28.6% perineal integrity was preserved, and 45.5% suffered spontaneous lacerations. The likelihood of episiotomy increases with nulliparity (OR=3.0), prematurity (OR=2.3) and Apgar score < 7 in the first minute (OR=2.1), while the chance of second-degree laceration associated with weight of the newborn > 3,300g (OR=1.6). We concluded that perineal outcome was associated with parity, prematurity, weight and vitality of the newborn.

El objetivo fue asociar la integridad perineal, laceración espontánea y episiotomía en partos normales con la edad materna, paridad, edad gestacional, peso y vitalidad del recién nacido. Estudio transversal realizado en el Hospital General de Itapecerica da Serra, São Paulo – Brasil, de noviembre de 2000 a junio de 2002, con 6.365 nacimientos, entre 1999 y 2001. Se realizó análisis descriptivo y regresión logística uni y multivariada, con cálculo de odds ratio ajustada con intervalo de confianza de 95%. Los resultados indicaron que 25,9% de las mujeres sufrieron episiotomía; 28,6% tenían la integridad perineal conservada; 45,5% presentaban laceraciones espontáneas. El chance de episiotomía aumenta con la nuliparidad (OR=3,0), prematuridad (OR=2,3) y Apgar <7 en el primer minuto (OR=2,1), mientras que el chance de laceración de segundo grado se asocia con el peso del recién nacido >3.300g (OR=1,6). Se concluyó que el desenlace perineal se asoció con la paridad, prematuridad, peso y vitalidad del recién nacido.

Accidentalidad por fluidos biológicos en profesionales de laboratorios clínicos de Maracaibo, Venezuela / Biological fluid-related accidents amongst professionals working in clinical laboratories in Maracaibo, Venezuela

Objetivo Determinar la exposición laboral accidental a fluidos biológicos por contacto percutáneo en el personal Bioanalista de Laboratorios Clínicos públicos, sus factores asociados y el cumplimiento de medidas post exposición biológica. Métodos Se realizó un estudio descriptivo transversal, la muestra fue de 156 bioanalistas adscritos a laboratorios clínicos del área metropolitana del estado Zulia. Para la recolección de datos se aplicó un instrumento de escalas que exploró la exposición percutánea, los factores vinculados y el cumplimiento de medidas post exposición biológica. Resultados Se evidenció exposición por accidentes percutáneos, representados principalmente por pinchazos y cortaduras, detectados en razón de su ocurrencia en un nivel moderado (media entre 2-3,99). Como factores vinculados a la accidentabilidad percutánea, se registra la ocurrencia en nivel moderado con diversas agujas huecas, con sangre y hemoderivados, en manos y dedos, con una severidad superficial, en áreas de toma y procesamiento de muestras durante el re-encapuchado de objetos punzo cortantes. Un nivel de mediano cumplimiento se obtuvo para el manejo post exposición. Existe relación entre la exposición percutánea con el nivel de cumplimiento detectado para el manejo post exposición p <0,001. Conclusión La magnitud y características de la exposición a fluidos biológicos detectada en este colectivo laboral reviste una problemática que puede impactar en la salud del personal y debe ser abordada institucionalmente para una efectiva gestión de prevención y control de riesgo.

Objective Determining the occupational exposure to biological fluids of medical technicians working in public clinical laboratories caused by accidental percutaneous contact, associated factors and compliance with post-exposure biological measures. Methods This was a descriptive cross-sectional study. The sample consisted of 156 medical technicians assigned to clinical laboratories in the metropolitan area of Zulia state in Venezuela. Data was collected by applying an instrument for exploring exposure and related factors, as well as compliance with established post-biological exposure measures. Results There was evidence of exposure caused by percutaneous accidents, mainly represented by a moderate level of needle-pricks and cuts (2-3.99 mean). There was a moderate level of factors regarding percutaneous injury in the hands and fingers associated with hollow needles, blood and blood products and superficial severity in sample taking and processing areas when recapping needles or handling sharp or cutting objects. A medium level (2-3.99 mean) of compliance was obtained for post-exposure handling. A significant correlation was found (p<001) between percutaneous exposure and level of compliance with post-exposure management. Conclusion The magnitude and characteristics of exposure to biological fluids detected in this work represents a problematic situation which can affect staff health and must be approached by institutions to ensure effective prevention management and risk control.

Childhood trauma profile at a tertiary care hospital in India.

Childhood injuries are the leading cause of morbidity and mortality worldwide. We evaluated the type of pediatric injuries encountered in the emergency room amongst 225 children (boys 151, girls 64; age range, 2 mo-12 yr). Data were collected using a structured injury proforma over a period of 12 months. Injuries occurred at home (n=137, 60.8%), street (n=38, 16.8%), and playground (n=37, 16.4%). Most frequent injuries were falls (n=144, 64%) and road traffic injuries (RTI) (n=37, 16.4%). Injuries mostly consisted of fractures (n=72, 32%), bruises (n=39, 17.3%), and lacerations (n=35, 15.5%). Child abuse was recognized in 7 (3.5%) children. There was an average delay of 2 hour 50 minutes to reach the medical facility.

A study on mass hysteria (monkey men?) victims in East Delhi.

During the summer month of May 2001 East Delhi came in grip of an outbreak of mass hysteria. Initial reports alleged that some monkey like creature attacked and caused injuries among number of persons. A medical board was set up to examine and find out the cause of injuries in the victims of the outbreak as a part exercise to apprehend the culprit. The study describes the sociodemographic pattern and injuries observed in these cases. Majority of victims were adult males, belonging to low socioeconomic strata and having low educational level. The incidents occurred mainly during night at the time of power failure. The type, distribution and characteristic of the injuries suggested of their accidental nature. The paper also discusses the role of forensic experts and press in such outbreak.

A survey of cutlass ("Collins") injuries seen in the emergency department of the Queen Elizabeth Hospital in Barbados

For the period March to November 1998 inclusive, a prospective survey was conducted of all patients who sustained injuries with a cutlass or machete and were admitted to the Accident and Emergency Department of the Queen Elizabeth Hospital. Of the 77 patient admissions, 81 (62/77) were male. The average age was 28.8 years (range 8 to 73 years; standard deviation 13.1). Twenty-two per cent of the patients were less than 20 years old. The most common locations of the lacerations were upper extremity (59 lacerations) and scalp (16 lacerations). Thirty-four per cent of the patients (26/77) sustained lacerations to two or more anatomical locations. There were 23 fractures in 21 patients; skull fractures were the most common fractures (11). Of the 63 patients who responded to the question on whether they knew the identity of their assailants, 51 reported that they were attacked by someone known to them; eight were assaulted by a spouse or known family member. Eighty-six per cent of patients (66/77) were treated in the emergency room and discharged. Of the 11 patients admitted, eight required treatment in the operating theatre. The average length of stay was 3.6 days. There were no amputations or deaths. One patient sustained loss of vision in one eye. In Barbados, most victims of cutlass injuries are males who know their assailants and the morbidity is most often related to head injuries and to short-term physical disability due especially to lacerations of the hand and forearm.