Recommending lateral episiotomy for nulliparous women requiring vacuum extraction could reduce the risk of obstetric anal sphincter injury by more than 50%, a real-world study suggests.

While episiotomy led to more wound infections, Swedish researchers found no difference in rates of postpartum pain, blood loss or neonatal outcomes between those with and without the procedure.

The clinicians say their study, published in The BMJ, is the first “adequately sized” randomised controlled trial to compare episiotomy with no episiotomy in vacuum assisted delivery.

A total of 702 women at ≥34 weeks’ gestation, half of whom were assigned to the intervention, were included in the trial.