Abstract Background: Episiotomy is a term used to describe a (simple) surgical procedure that is usually done using surgical scissors to widen the opening of the vagina at the time of the birth of the child's head to protect the mother from injury to the anal area during childbirth. Aim of Study: To assess efficacy of limited mediolateral episiotomy during delivery of primigravidae regarding maternal and neonatal outcome. Patient and Method: This randomized controlled trial was conducted in the Emergency Unit of Obstetrics and Gynaecology Department at Kasr Al-Aini Hospital, Cairo University, in the period from March 2019 to November 2019. Results: Our study regarding to demographic data showed that no statistically difference in the term of age, 2nd stage duration, neonatal weight and gestational age >0.05. Our study regarding to Perineal injuries showed that was statistically difference in the term of Perineal injuriesvs age, Perineal injuries vs 2nd stage duration and Perineal injuries vs neonatal weight <0.05. Our study regarding to vaginal injuries showed that was statistically difference in the term of vaginal injuries vs age, vaginal injuries vs 2nd stage duration and vaginal injuries vs neonatal weight <0.05. Conclusion: The research shows that the use of the limited vaginal Episiotomy is safe for both mother and child as long as it is applied by people in the field of obstetrics with experience. Episiotomy can be used in cases where the child is tired during childbirth or when there is a wound in the perineum that continues to expand towards the anus, in order to redirect the wound to prevent major injuries and long-term complications.