A patient presents with periviable preterm prelabor rupture of membranes (PPROM) at 22 weeks. Management of patients presenting with periviable PPROM is complex and dependent upon patient desires as well as availability of neonatal care, termination capabilities, and local laws. Initial evaluation after diagnosis of periviable PPROM includes evaluation for preterm labor, intraamniotic infection and placental abruption. In the absence of these scenarios, this patient would be counseled on the maternal and fetal risks of continuing the pregnancy, including but not limited to intraamniotic infection and its potential sequelae including maternal sepsis and death, risk of preterm delivery, and fetal risks such as pulmonary hypoplasia, limb contractures and neonatal death. After being counseled on the pregnancy prognosis, the patient may opt for pregnancy continuation or for pregnancy termination either by dilation and evacuation or labor induction. Antenatal steroids, magnesium sulfate, and short-term tocolytics are recommended in certain patients with periviable PPROM and in most circumstances, patients at 23 0/7 weeks’ gestation or later are candidates for these interventions. Administration of antibiotics to prevent infection or “latency antibiotics” is reasonable as early as 20 0/7 weeks’ gestation.