This thesis describes the impact and the complexity of the diagnosis and management of late-onset fetal growth restriction. Fetal growth restriction is a condition in which the fetus is unable to reach its intrinsic growth potential due to reduced placental function. The lack of oxygen and nutrients hampers the fetus from optimal growth and development. Late-onset fetal growth restriction affects a high number of pregnancies and has a large societal impact in terms of adverse outcomes and an increased risk for the development of cardiovascular disease later in life. This thesis emphasizes that the detection of these fetuses at risk is challenging because symptoms may be subtle at term gestation. Small size as stand-alone modality is only moderately predictive and unreliable. The condition affects both small fetuses and fetuses who are within ‘normal’ birth weight ranges. Small- or large fetal size does not necessarily reflect pathology but puts the fetus at a higher risk and an appropriate size is not a guarantee of normal outcomes. The observed large heterogeneity in Dutch hospital protocols underlines the complexity of the condition. To overcome some of the inconsistencies, a consensus definition and core outcome set were developed. Furthermore, two research protocols to investigate the role of Doppler ultrasound as a marker of placental function in the management of late-onset fetal growth restriction are outlined. The challenge for the coming decade is to implement the consensus definitions and to evaluate (new) placental markers to improve identification of the compromised fetuses at (near) term gestation.