The management of pregnant patients with premature rupture of membranes (PROM) prior to 32 weeks' gestation or at 32 to 34 weeks' gestation is controversial. In a retrospective analysis of 109 patients with PROM at or prior to 34 weeks' gestation, 53 (49%) were managed conservatively, and labor was either induced or occurred spontaneously within 24 hours in 56 (51%). Patients initially presenting with chorioamnionitis were excluded from this study, as were all patients with evidence of a fetal anomaly or a medical indication for delivery. The 53 patients managed conservatively had a mean pregnancy prolongation of 21 days (range, 2 to 105 days; median, 7 days). The infants of patients managed conservatively had a lower incidence of respiratory distress syndrome (P<.0025), mortality (P<.05), and intracranial hemorrhage (P<.03). Sixty-four percent of the conservatively managed group versus 45% of the induced/ spontaneous labor group were found to be normal upon physical and neurologic examination when discharged from the hospital (P<.035). The difference in incidence of neonatal sepsis between these 2 groups was not statistically significant (P =.42). Immediate induction of labor and/or delivery for patients with PROM at less than 32 weeks' gestation resulted in a significant increase in perinatal mortality and morbidity. © 1982 by The American College of Obstetricians and Gynecologists.