Preterm premature rupture of membranes remains an important cause of preterm birth and neonatal morbidity and mortality. Although the underlying pathophysiology remains largely undefined, subclinical infection has been implicated both in the mechanism of membrane rupture and the resultant neonatal morbidity. The use of maternal systemic antibiotics reduces both neonatal and maternal morbidity in the expectant management of PPROM. Although concern persists over the development of resistant strains of organisms involved with neonatal sepsis, current data support the use of antibiotics in this setting. Further study is needed regarding the risks and benefits of additional tocolytic therapy or antenatal corticosteroids in the management of PPROM, and the predictors of successful and unsuccessful conservative management, and subclinical intrauterine infection. This will be helpful in the ultimate delineation of the optimal management scheme for PPROM.