Obstetricians should identify fetuses at risk of developing growth restriction, design a comprehensive surveillance plan, and carefully chose the time and mode of delivery. FGR due to placental insufficiency is diagnosed when decreased amniotic fluid volume, abnormal umbilical artery Doppler and failure of growth are evident using serial growth scans, provided that chromosomal abnormalities, malformations and infections are excluded. Antenatal surveillance should be instituted on the basis of the severity of the maternal or fetal condition, with an emphasis on Doppler analysis as the most important tool to grade the severity of the fetal disease.