Despite a plethora of publications existing in the literature, there is still confusion about the definition and management of intrauterine growth-restricted fetuses. A second source of confusion lies in the fundamental misunderstanding that all growth-restricted fetuses are the same and all will progress to cardiovascular failure following a similar time frame. Once intrauterine growth restriction is identified, obstetrical management is focused on assuring safety while the fetus continues to mature within a potentially hostile intrauterine environment. In the United States, the approach to management and delivery of the premature growth-restricted fetus is often based on serial biophysical profile evaluations, whereas in Europe it is usually based on the result of the cardiotocography. However, there is no single test that seems superior to the other available tests for timing the delivery of the growth-restricted fetus. Therefore, the decision to deliver a fetus, especially at <32 weeks, remains mostly on the basis of empirical management. The staging system may allow comparison of outcome data for IUGR fetuses and may be valuable in determining more timely delivery for these high-risk fetuses. Most investigators agree that Doppler ultrasonography of the umbilical artery and the middle cerebral arteries, in combination with biometry provides the best tool to identify small fetuses at risk for adverse outcomes. The umbilical artery and the middle cerebral artery are the two vessels that have been extensively studied. Recent studies have looked into the analysis of the fetal venous system and the association between changes in this system with the fetal outcome.