Intrauterine growth restriction (IUGR) is the failure to achieve the genetically predetermined growth potential and may be caused by maternal, fetal, placental, and external factors. IUGR is associated not only with a marked increased risk in perinatal mortality and morbidity but also with long-term outcome risks. IUGR is clinically suspected when ultrasonographic estimates of fetal size, simmetry or weight result abnormal. Exclusion of structural and/or chromosomal anomalies and Doppler studies of maternal and fetal circulations is the most effective method to differentiate IUGR fetuses secondary to placental dysfunction from those secondary to aneuploidy, genetic syndromes, and intrauterine infections. This review summarizes the current knowledge about fetal hemodynamics in IUGR pregnancies and its relationship with the severity of the disease. A better understanding of fetal hemodynamic changes occurring in IUGR will likely lead to targeted monitoring intervals in such fetuses leading to an appropriate timing of delivery only when fetal risks exceed neonatal risks.