Approximately 0.5% of all births occur before the 3rd trimester of pregnancy, and very early deliveries result in the majority of neonatal deaths and more than 40% of infant deaths. Preterm prelabor rupture of membranes (PPROM) is a known risk factor for preterm birth and is responsible for 30–40% of preterm deliveries. While PROM occurs around 8% of all (term) pregnancies, PPROM occurs around 1% of the time. Periviable birth is delivery occurring from 20 0/7 weeks to 25 6/7 weeks of gestation. Women who experience PPROM before 27 weeks have a 10% risk of early PPROM and a 35% risk of preterm delivery in a subsequent pregnancy. Despite improvements in perinatal and neonatal care, infants born at <26 weeks of gestation contribute disproportionately to neonatal mortality and morbidity. When delivery is anticipated near the limit of viability, families and health care teams are faced with complex and ethically challenging decisions. In this episode, we will review the latest data on previable and periviable PPROM based on a new SMFM Consult Series (#71), released July 15, 2024. Is amnioinstillation of fluid into the uterus an option? What about home outpatient management? Listen in for the data.