ABSTRACTThrombocytopenia in the fetus must be anticipated when the mother has or has had idiopathic thrombocytopenic purpura (ITP). Although maternal morbidity and mortality is extremely low, the overall fetal mortality is high and ranges from 13–25%. The mortality in almost all cases is due to intracranial hemorrhage and appears to be related to the events surrounding labor and delivery. At the present time, the only guide to possible fetal involvement is the activity of the ITP process in the mother. In this review the current state of the art is examined. A scheme for the management of these cases at the time of expected date of confinement is proposed and is based upon the maternal and fetal platelet counts, maternal response to corticosteroids, and obstetrical considerations. It is recommended that cesarean section be given strong consideration when significant fetal involvement is anticipated or demonstrated by fetal scalp blood platelet level.