Objective To compare the maternal and neonatal outcomes of
operative vaginal delivery in relation to the use of episiotomy.
Design Pilot randomised controlled trial (RCT).
Setting Two urban maternity units in Scotland and England.
Sample Nulliparous women anticipating a singleton cephalic
vaginal delivery were recruited in the antenatal period.
Methods If an operative vaginal delivery was required in the
second stage of labour, women were randomised to either routine
(in all cases) or restrictive (only if tearing apparent) use of
episiotomy.
Main outcome measures The primary outcome was anal sphincter
tearing (third or fourth degree). Secondary outcomes included
postpartum haemorrhage (PPH), neonatal trauma and pelvic floor
symptoms up until 10 days postpartum.