Introduction Extreme preterm premature rupture of membranes is a rare condition. Although significant pregnancy prolongation occurs in many cases with expectant management, neonatal outcomes remain poor.

Material and Methods 23 patients were studied over a 3 year period. Patients were hospitalised on confirmation of extreme preterm premature (≤24 weeks) spontaneous rupture of membranes. They were counselled regarding the poor outcome of both the pregnancy and also the baby if it were to reach viable gestation. They all declined termination of pregnancy. They all had speculum examinations to confirm loss of liquor and/or scan confirmation of oligohydramnious. They were monitored with weekly full blood count, C-reactive protein and given oral antibiotic prophylaxis. Those patients who reached 24 weeks gestation were given antenatal steroids.

Results Median gestational age at rupture of membranes was 20.0 weeks (range 16.9–23 weeks); One patient reached term and her data were excluded from analysis due to extreme skewing of results. Of the remaining, median latency period to delivery was 13 days (range 7–96 days), with mean gestational age at delivery of 23.8±3.4 weeks. Overall survival was <10%. Placental pathology and in some cases limited postmortem indicated chorioamnionitis.

Conclusion This study shows that although significant pregnancy prolongation after previable rupture of membranes occurs in some cases pregnancy outcomes in the majority remain very poor.