Background:Thrombocytopenia often occurs in pregnancy, ranking as the second most common hematologic abnormality following anemia. It affects approximately 6% to 10% of pregnant women.1 This research aimed to explore the factors linked to thrombocytopenia among rural Indian women in their third trimester of pregnancy. Methods:This prospective observational study was conducted at Dr.BalasahebVikhePatil Rural Medical College and Dr.VitthalraoVikhePatilsPravara Rural Hospital in India. The study specifically targeted rural Indian women in their third trimester of pregnancy with a platelet count below 150,000 per cubic millimeter. Results:In the present study, among the 86 cases examined, the largest proportion (44.2%) were diagnosed with Gestational Thrombocytopenia, followed by 27.9% diagnosed with hypertensive disorders of pregnancy and 16.3% with HELLP syndrome. Among the 39 cases of gestational thrombocytopenia, 41.01% were categorized as mild thrombocytopenia. Of the 38 cases of hypertensive disorders of pregnancy accompanied by thrombocytopenia, 63% were associated with pre-eclampsia and 36.8% with HELLP syndrome. Additionally, 61.6% of the babies were born with low birth weight, and 73.5% of these cases were linked to maternal platelet counts below 100,000 per cubic millimeter.. Conclusions:The research underscores gestational thrombocytopenia as the leading cause during the third trimester, followed by hypertensive disorders such as pre-eclampsia and HELLP syndrome. It emphasizes the need for careful monitoring, particularly for first-time mothers and those in their third trimester, due to increased risks. The link between maternal platelet count and neonatal outcomes, particularly low birth weight, highlights the complex relationship between maternal health and fetal well-being.