Objective: To evaluate the relation between the degree of the striae gravidarum (SG) and the incidence of vaginal or perineal lacerations and the consequent need for episiotomy.Study design: This cross-sectional multicentre observational study was carried out on 466 pregnant delivered in Cairo, Ain Shams Universities and private hospitals. The striae gravidarum (SG) was assessed according to the numerical scoring system of Atwal. The primary outcome of this study was the occurrence of vaginal or perineal lacerations and the need for episiotomy in relation to the degree of the SG.Results: The incidence of vaginal, perineal lacerations and the need for episiotomy increased significantly with higher degrees of total striae score (TSS) ( 6.82 ±3.77 vs. 3.27 ±2.84, P < 0.001, 6.1 ±3.38 vs 4.14 ±3.57, P <0.001 and 4.79 ±3.73 vs. 3.96 ±3.33, P = 0.018 respectively) . There was a significant correlation between perineal lacerations and TTS (P <0.001),lower parity (P = 0.002) , fetal head position (P0.002), Higher gestational age ( P= 0.015), the need for episiotomy (P <0.0010, occurrence of vaginal lacerations and its length (P <0.001 and 0.002 respectively) and higher neonatal birth weight (P = 0.002). There was also a significant correlation between vaginal lacerations and older maternal age (P = 0.023), Body mass index (P = 0.004), TTS (P <0.001), ), the need for episiotomy (P =0.012, occurrence of perineal lacerations and its length (P <0.001) and higher neonatal birth weight (P = 0.012).Conclusion: TTS of SG assessed prenatally could predict occurrence of vaginal, perineal lacerations and the need for episiotomy.