Normal fetal growth depends on maternal, fetal, placental, and external factors combined with genetically predetermined growth potential. Categorization of decreased size by etiology is very important as not every small fetus has equal risk of adverse sequelae. The early and accurate diagnosis of IUGR may reduce the incidence of morbidity and mortality of fetuses with this condition. The question of when to deliver a growth restricted fetus has no straight forward answer. The mode of delivery for fetuses with IUGR should be based entirely on standard obstetric practices. There is no evidence to support a policy of routine cesarean delivery for all fetuses with IUGR.