Objective：To explore the factors influencing lateral episiotomy in vaginal deliveries of suspected macrosomia. Methods： The clinical data of 149 pregnant women with suspected macrosomia who delivered at the Obstetrics Department of the First Affiliated Hospital of Nanjing Medical University from January to July 2022 were analyzed retrospectively. According to whether the perineum was cut laterally during vaginal delivery，the perineum was divided into two groups：the episiotomy group and the natural laceration group. Risk factors for vaginal delivery in pregnant women with suspected macrosomia were analyzed. Results：Among 149 pregnant women with suspected macrosomia，lateral episiotomy was performed in 40 cases（26.85%），while 109 cases（73.15%）had vaginal deliveries accompanied by natural laceration，including 93 cases of Grade Ⅰ laceration and 16 cases of Grade Ⅱ laceration. The proportion of primipara and midwives with less than 5 years of experience was higher in the episiotomy group compared to the laceration group（P ＜ 0.001，P=0.021）；the proportion of the second stage of labor less than 47 min in the episiotomy group was significantly higher than that in the natural laceration group（87.5% vs. 39.4%，P ＜ 0.001）. In addition，the proportion of amniotic fluid properties（clear +Ⅰ degree）in the natural laceration group was significantly higher than that in the episiotomy group（87.2% vs. 72.5%，P=0.034），while the rate of postpartum hemorrhage was significantly lower than that in natural laceration group（P=0.010）. Primipara and midwives with less than 5 years of experience were independent risk factors for episiotomy in suspected macrosomia （OR=2.708，P=0.021）. Conclusion：The incidence of lateral episiotomy in vaginal delivery of suspected macrosomia increases in primipara and midwives with less than 5 years of experience，at the same time，the rate of postpartum hemorrhage in the lateral episiotomy group is significantly reduced.