The severe risk situations characterized by fetal growth retardation are outlined. The small fetus, whether growth retarded or severely premature, is best delivered where both fetal monitoring and newborn resuscitation are available. The moderate risk fetus can be monitored at home base with clinical skills described in this article.The recognition of fetal intrauterine growth retardation using a simple tool (tape measure) is stressed, and the criteria for interpretation of FHR patterns are briefly reviewed, with their relationships to true fetal distress.