Intrauterine fetal growth restriction is a major cause of perinatal morbidity and mortality in developed countries. Establishing this diagnosis is difficult. When this problem is eventually identified, the management of the affected pregnancy is often challenging. This is because distinguishing the small baby that is constitutionally normal, from the baby with an intrinsic problem, or suffering from placental insufficiency, is difficult. After accurately identifying the fetus at risk of hypoxia from uteroplacental insufficiency, there is the dilemma of determining the optimum time of delivery. The risk of premature delivery has to be weighed against the risk of fetal demise from intrauterine hypoxia. This review outlines the fetal biometric indices by which the diagnosis of a fetus that is ‘small for gestational age’ is made. The place of serial scans for fetal biometry, and the range of functional studies for fetal surveillance are discussed. Factors that should influence the timing of delivery are mentioned and some recent advances in fetal surveillance are highlighted.
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