Placental insufficiency can lead to impaired fetal growth and can impose adverse perinatal outcomes. Interventions to alter these pathophysiologic outcomes are lacking. Fetal growth restriction (FGR) is diagnosed when the fetus shows clinical signs of malnourishment and/or hypoxia due to placental insufficiency. In early-onset FGR, the obstetric challenge lies in the timing of delivery, whereas in late-onset FGR, the diagnosis itself is difficult.Thus, monitoring in early-onset FGR is advocated for optimizing the timing of iatrogenic preterm delivery. Cardiotocography and Doppler ultrasound can be used for this purpose. On the other hand, identifying the fetus at risk for immediate hypoxia and those who may benefit from an early delivery remain challenging in cases with late-onset FGR. The available investigative markers correlate inaccurately and fail to define the outcomes.Further studies are necessary to determine how to best assimilate different monitoring variables and other prognostic markers in risk models (estimated fetal size with markers of placental insufficiency) to strategize individual treatment plans.Source: Obstetrics and Gynecology Clinics of North America. 2021 Jun;48(2):371-385. doi: 10.1016/j.ogc.2021.02.007.