Intrauterine growth restriction is used to describe a fetus whose birth weight is below the 10th percentile or < 2 SD below the mean weight for that gestational age and/or abdominal circumference is less than 10th percentile. Diverse factors, including intrinsic fetal conditions as well as maternal and environmental factors, can lead to intrauterine growth restriction (IUGR). Small for gestational age fetus is at increased risk for perinatal morbidity and mortality. All the pregnancies should be screened for IUGR by using serial fundal height measurements. Ultrasonography in the third trimester to monitor growth velocity of fetus and measurement of abdominal circumference can detect 80% of IUGR fetuses. After diagnosis of IUGR is confirmed, fetal monitoring should be done with DFMR and biweekly NST. Other tests of fetal well-being include standard or modified biophysical profile, Doppler blood flow velocimetry in umbilical and middle cerebral arteries and contraction stress test. Management includes bed rest in lateral position, removal of risk factors like smoking and intake of alcohol and treatment of infections and medical disorders. Other interventions which can be tried are nutrient supplementation— like increasing protein, essential amino acids, zinc and calcium intake, addition of low dose aspirin, plasma volume expanders, maternal oxygen therapy and heparin. The timing of intervention and mode of delivery is very important and should be individualized, as there is progressive metabolic deterioration in IUGR endangering the life of the fetus. With limited options available for intrauterine treatment, an early delivery may be necessary but the consequences of prematurity should be weighed against risk of IUD. Delaying delivery may result in a hypoxic, acidotic infant with long-term neurological sequelae.