Fetal macrosomia, defined as birth weight >4,000 grams at any gestational age, is an important consideration for management of delivery, especially when complicated by preexisting and gestational diabetes, maternal obesity, post-term gestation, and history of macrosomia in prior pregnancy. While no exact measurement of fetal weight exists, fetal biometry is used to calculate an estimated fetal weight (EFW) when assessing for suspected macrosomia. When macrosomia is suspected, consideration of both fetal/neonatal and maternal morbidity must be considered when counseling patients on timing and mode of delivery. Fetal risks of macrosomia include shoulder dystocia and subsequent birth trauma, including clavicular fracture, brachial plexus injury, and complications related to hypoxia and impaired oxygenation during prolonged delivery. Maternal risks involve increased need for cesarean delivery, severe perineal lacerations, and postpartum hemorrhage. While most vaginal deliveries of pregnancies suspected to be affected by fetal macrosomia are uncomplicated and do not involve shoulder dystocia, scheduled cesarean deliveries may be beneficial in individuals with EFW of 4,500 grams or more with diabetes or individuals with EFW of 5,000 grams or more without diabetes.