Background <p>Forceps-assisted vaginal delivery is prone to perineal laceration and other complications. Episiotomy decisions are often experience-dependent, leading to excessive intervention. The Perineal Evaluation Form (PEF) provides an objective basis for episiotomy, but its clinical efficacy in forceps-assisted vaginal delivery has not been fully validated.</p> Methods <p>A single-center retrospective cohort study was conducted on 313 parturients who underwent forceps-assisted vaginal delivery at the Third Affiliated Hospital of Zhengzhou University from January 2017 to December 2024, divided into PEF group (n=194, PEF-guided elective episiotomy) and non-PEF group (n=119, clinician-experience-based episiotomy). Maternal and neonatal outcomes were compared, and multivariate binary logistic regression identified influencing factors of episiotomy.</p> Results <p>The PEF group had a significantly lower episiotomy rate, a shorter second stage of labor, less postpartum 24-hour blood loss, and a lower neonatal transfer rate (all P&lt;0.05). No significant differences were found in severe perineal laceration, other maternal complications or short-term neonatal outcomes (all P&gt;0.05). PEF-guided episiotomy, multiparity and epidural analgesia were protective factors; Class II/III fetal heart rate (FHR) monitoring, oxytocin use and gestational diabetes mellitus (GDM) were risk factors (all P&lt;0.05).</p> Conclusions <p>PEF-guided elective episiotomy is safe and effective in forceps-assisted delivery, which reduces unnecessary clinical interventions without increasing the risk of severe maternal and neonatal complications. The identified influencing factors provide an evidence-based basis for precise episiotomy decision-making.</p>