The authors retrospectively evaluated maternal and fetal outcomes of 73 consecutive singleton pregnancies complicated by preterm premature rupture of amniotic membranes. When preterm labor occurred and fetuses were at a viable gestational age, pregnant patients were managed aggressively with tocolytic therapy, antenatal corticosteroid injections, and antenatal fetal testing. The mean gestational age at the onset of membrane rupture and delivery was 22.1 weeks and 23.8 weeks, respectively. The latency from membrane rupture to delivery ranged from 0 to 83 days with a mean of 8.6 days. Among the 73 pregnant patients, there were 22 (30.1%) stillbirths and 13 (17.8%) neonatal deaths, resulting in a perinatal death rate of 47.9%. The perinatal survival rate based on gestational age at the onset of fetal membrane rupture was 12.1% at less than 23 weeks of gestation, 60% at 23 weeks, and 100% at 24 to 26 weeks. Maternal morbidity was minimal with puerperal endomyometritis in 5 (6.8%) cases, one of which became septic; however, there was no long-term sequela. Eight (15.7%) liveborn infants had pulmonary hypoplasia, 5 (62.5%) of which resulted in neonatal death. In 33 (45.2%) patients, amniotic membranes ruptured before 23 weeks of gestation. At previable gestational age, the risk of neonatal pulmonary hypoplasia appears to be primarily dependent on gestational age at the onset of premature rupture of membrane rather than gestational age at delivery. Pregnancy outcomes remain dismal when the fetal membrane ruptures before 23 weeks of gestation.