Objectives: To compare the maternal and fetal outcome in routine versus selective episiotomy in primigravidae. Study Design: A randomized controlled trial conducted at Jinnah Hospital, Lahore, Pakistan. The two interventions compared were selective (limited to specified maternal or fetal indications) and routine episiotomy (following the hospital policy). 200 primigravidae were included in the study, 100 women in each group. The main outcome measure was severe perineal trauma (3rd degree and 4th degree tear). Results: Episiotomy was made in 32% of deliveries in the selected and 100% in the routine group. Severe perineal trauma was not seen in either group. Anterior vaginal/ Paraurethral trauma was more common in the selected group. However, posterior surgical repair, perineal pain, wound dehiscence and other healing complications were all less frequent in selected group.