Objects: To investigate pregnancy management of pregnancy with moderate to severe thrombocytopenia and its effect on maternal and fetal outcomes. Methods: The clinical data of 214 pregnant women with thrombocytopenia who delivered in the first affiliated hospital of Nanjing Medical University from January 2016 to December 2020 were retrospectively analyzed. Results: In 214 pregnant women with thrombocytopenia, there was no significant difference in BMI, times of pregnancy, times of labor and past medical history between mild thrombocytopenia group and moderate to severe thrombocytopenia group (P > 0.05). However, patients with moderate to severe thrombocytopenia in pregnancy were older (P = 0.03), the gestational age of thrombocytopenia was earlier (P < 0.001), the cesarean section rate of delivery mode was higher than that of mild thrombocytopenia in pregnancy (P = 0.001), the amount of intrapartum hemorrhage was significantly increased (P = 0.019), and the Apgar score of newborn was lower (P < 0.001).At the same time, the correlation analysis between the severity of the lowest PLT during pregnancy and the amount of intrapartum blood loss and neonatal outcome showed that the severity of the lowest blood platelets during pregnancy was positively correlated with the amount of intrapartum blood loss and neonatal outcome(r=0．102, P=0.049; r= -0.347, P<0.001). Conclusions: For pregnant women with moderate to severe thrombocytopenia, intrapartum hemorrhage is common, which can easily cause fetal distress. For pregnancy complicated with thrombocytopenia, especially in patients with moderate to severe thrombocytopenia, it is necessary to carry out reasonable and effective intervention as soon as possible and individualized selection of delivery mode, so as to improve the maternal and infant outcomes.