Aim. Authors analyzed incidence and predictors of fetal macroso-mia, considering its contribution in obstetric morbility and neonatal complications. Method. 6.692 pregnant women gave birth at the P.O. Santo Bambino University Hospital "Policlinico - V. Emanuele" Catania from the 1st of January 2010 to the 31st of December 2012. Every healthy child, full-term, with weight equal to or greater than 4.000 g was classified as macrosoma. Mode of delivery, indications for cesarean section, incidence of shoulder dystocia, clavicle fracture, perineal laceration and postpartum haemorrhage were evaluated. Data were analyzed using the Chi-square test with a level of statistical significance determined by a value of P <0.05. Results. 305 cases of macrosomia were found. In macrosomia group 157 (51.4%) caesarean sections and 148 spontaneous delivery (48.5%) were carried out, while in control group there were 134 cae-sarean sections (43.9%) and 171 spontaneous (56%). The increased use of operative delivery in macrosomia group compared to control was not statistically significant (P=0.074). The most frequent indications for cesarean section in macrosomia group were: cephalo-pelvic disproportion (12.1%), uterine inertia (7.8%) and unengaged fetal head (6.8%). Conclusions. Fetal macrosomia is not an indication to elective caesarean section. Vaginal delivery, when macrosomia is suspected and there is no contraindication, still remains the safest mode of delivery.