The accurate diagnosis of intrauterine growth restriction (IUGR) is achieved using a combination of clinical examination, relevant laboratory tests, and a variety of ultrasound techniques, including detailed anatomical scanning, placental evaluation, and Doppler assessment of placental and fetal vessels. The risk factors for IUGR are increasing over time and these include increased maternal age, coexistent medical problems, and assisted reproductive technology. Fetal causes of IUGR may be classified according to genetic diseases, congenital malformations, infections, and multiple gestation. Once a diagnosis has been established, consideration of the need for further investigations, consultation, or advice from a regional perinatal center and ongoing maternal-fetal surveillance should be instituted. Management will be directed according to the presence or absence of uteroplacental vascular insufficiency. The optimal timing of delivery is currently the source of much controversy, due to the many relevant clinical and ultrasound factors that clinicians must consider, in addition to patient preferences.