Objective: To investigate the association between premature thrombocytopenia and placental lesions. Methods: Cases included singleton premature infants admitted to the neonatal intensive care unit of Guangdong Women and Children’s Hospital, Guangzhou Medical University from January 1, 2015 to December 31, 2015 with platelet counts 100×109/L. We selected a contemporaneous control group matched for gestational age. The frequency of fetal thrombotic vasculopathy, infarcts, cord insertion and histological inflammation were identified on retrospectively reviewed. Pearson Chi-Square Test was used to test for associations analyzation. Results: The average gestational age of the thrombocytopenia group (106 cases) and the control group (198 cases) was (31.74±2.10) weeks and (31.92±2.06) weeks, respectively. The birth weight of the preterm neonates in the control group [(1 763.59±429.36) g] Was higher than that of the experimental group [(1 659.72±422.21) g], the difference was statistically significant (P<0.05). The rate of placental insufficiency (preeclampsia 17.9% and intrauterine growth retardation 9.4%) were higher than those in the control group (preeclampsia 6.1%, intrauterine growth retardation 2.5%); the difference was statistically significant (P<0.05). There was no significant difference in the average placental weight between the 2 groups [(381.98±107.10) g and (397.05±114.28) g]. The frequency of fetal thrombotic vasculopathy (23.6%) and placental infarcts (35.8%) in the thrombocytopenia group were higher, the difference was statistically significant (P<0.05). The frequency of histological inflammation and umbilical cord torsion between the groups are not statistically significant (P>0.05). Conclusion: Placental infarcts and poor fetal vascular lesions, but not histological inflammation, are associated with thrombocytopenia in the premature infants.