Background& Aim: Macrosomia, defined as a birth weight of 4000 g or above, is one of the most frequent prenatal problems so, the aim of this study was to assess the accuracy of clinical evaluation and 2D ultrasound examination in prediction of fetal macrosomia. Patients and methods: This study was carried out in the Obstetric and Gynecology Department of Al Azhar University Hospital. All pregnant who were admitted to our hospital and were delivered by CS indicated by prenatal diagnosis of fetal macrosomia were included in our study. Results: Fetal macrosomia is a common cause of maternal and newborn morbidity, with a frequency of 5.5 percent. Multiparity, prior history of macrosomia, diabetes mellitus, overweight, gestational age of 40 weeks or more, and maternal age of 30 to 39 years were all shown to be maternal risk factors for foetal macrosomia in our research. The results of our cross-sectional observational research indicate that ultrasonography is considerably more accurate than Leopold's manoeuvres in estimating foetal weight in overweight pregnant women. In normal-weight pregnant women, however, there was only a small statistically significant difference between the two techniques. Absolute error of prenatal estimation of fetal macrosomia in our study was high with obese and/or diabetic mothers and polyhydramnios. Conclusion: The data obtained in our cross sectional observational study show ultrasound to have a significantly better accuracy in fetal weight estimation in overweight pregnant women than Leopold's manoeuvres. However, limited statistically significant difference between the two methods was observed in normal weight pregnant women