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Introduction: Chronic Immune Thrombocytopenic Purpura (ITP) during pregnancy is a rare autoimmune disorder associated with significant maternal and fetal risks due to severe thrombocytopenia and increased bleeding complications, requiring multidisciplinary and individualized management. Aims & Objectives: To highlight the clinical challenges and therapeutic strategies for managing chronic ITP in pregnancy, focusing on platelet optimization, minimizing bleeding risks, and ensuring optimal maternal and fetal outcomes through a multidisciplinary approach. Case report: A G2P1 with Chronic ITP presented at 28 weeks of gestation with nasal bleeding and a platelet count of 10,000. She was managed with romiplostim, eltrombopag, azathioprine, prednisolone, IVIG, and serial platelet transfusions during pregnancy. Weekly platelet monitoring and multidisciplinary collaboration were pivotal in therapeutic decision-making. An emergency cesarean section was performed at 35+4 weeks due to a non-reassuring non-stress test, supported by perioperative platelet transfusions. Results: Platelet counts fluctuated throughout pregnancy, necessitating multiple therapeutic adjustments. Preoperatively, the platelet count was optimized with two SDP transfusions. Intra- and postoperative management included transfusions and stress-dose corticosteroids. The patient experienced no significant bleeding complications, and the postoperative course was uneventful. She was discharged with a platelet count of 40,000. Conclusions: Chronic ITP in pregnancy requires vigilant monitoring, dynamic treatment protocols, and multidisciplinary care to manage thrombocytopenia and bleeding risks effectively. Individualized approaches, including pharmacotherapy and perioperative platelet optimization, are essential to achieving favorable maternal and fetal outcomes.