Should Lateral Episiotomy Be Standard of Care for Vacuum-Assisted Delivery in Nulliparous Patients?

Episiotomy in assisted vaginal delivery is controversial, with marked variation in practice patterns (NEJM JW Womens Health Feb 2015 and JAMA 2015; 313:197). Evidence suggests there might be a role for lateral episiotomy for nulliparous patients requiring vacuum-assisted delivery. In this study, Swedish researchers identified 717 nulliparous women with a single live cephalic fetus at ≥34 weeks gestation who required vacuum assistance for delivery. They were randomized to receive standardized lateral episiotomy (beginning 1–3 cm from the posterior fourchette, at a 60° angle from the midline, and 4 cm long) or to no episiotomy.

Key results were as follows:

• Rate of obstetric anal sphincter injury, the primary outcome, was 13% in the no-episiotom…