Thrombocytopenia is a common occurrence in pregnancy, affecting 1 in 10 women. Differentiating gestational thrombocytopenia from immune thrombocytopenia (ITP) can be challenging, as no diagnostic tests exist. We will discuss a diagnostic approach to obstetric thrombocytopenia with a focus on identification of ITP, and differentiating from gestational thrombocytopenia. Management strategies will be discussed, including indications for treatment, target platelet thresholds for delivery and safety of neuraxial anaesthesia. The merits of corticosteroids compared with intravenous immunoglobulin will be canvassed, including efficacy and side effect profiles. Second-line treatment of maternal ITP will be discussed. The risk of neonatal thrombocytopenia will be explored and relevant precautions explained. Finally, the role of VTE prophylaxis in the setting of maternal thrombocytopenia will be discussed.