During implantation, apoptosis is critical for the appropriate tissue remodeling of the maternal decidua and invasion of the developing embryo. Yet the regulation of apoptosis is also imperative for a successful pregnancy. The quick and effective removal of apoptotic cells by tissue macrophages represents an essential process, which prevents the release of self-antigens and, in the case of pregnancy, paternal alloantigens. Recent studies have shown that the process of apoptotic cell clearance is not a neutral event, but rather an active one which induces macrophage production of anti-inflammatory cytokines and survival factors. Therefore, apoptotic cell clearance is necessary for the resolution of inflammatory conditions, which during pregnancy could have lethal consequences. The function of the maternal immune system during implantation and throughout pregnancy is, thus, an important area of investigation. This review will discuss the role of decidual macrophages in apoptotic cell clearance during pregnancy.