Severe perineal lacerations in nulliparous women and episiotomy type

If episiotomy is to be performed, it must be borne in mind that patients with a perineal length of ≤3 cm have an elevated risk of severe perineal lacerations, and if clinical or ultrasound examination suggests that the fetal head is large, mediolateral episiotomy may be preferred. Otherwise, midline episiotomy must be considered.