In the developed world, preterm birth is the biggest contributor to neonatal mortality and a leading cause of pediatric morbidity. The primary aim in the current management of preterm labor is of optimizing the condition of the fetus and provision of neonatal facilities. A shortened pregnancy may arguably reduce the risk of major complications like preeclampsia and venous thromboembolism. The sophistication and availability of neonatal intensive care is the major factor in ensuring survival in early preterm births. Survival of the preterm infant is also related to birth weight. At very preterm gestations, it is vital to involve parents in decision-making regarding labor management and resuscitation of the newborn. Fetal fibronectin is an extracellular matrix glycoprotein produced by fetal membranes and decidua. Corticosteroids administered antenatally to mothers are of proven efficacy in reducing neonatal mortality, respiratory distress syndrome and cerebral intraventricular hemorrhages by between 40 to 60 percent. Betamimetics have severe side effects including hypotension, myocardial ischemia, cardiac failure and pulmonary edema. Indomethacin has profound effects on fetal circulation. It is also used in the treatment of polyhydramnios and neonatal closure of patent ductus arteriosus. Preterm prelabor rupture of membranes (PPROM) is defined as spontaneous membrane rupture occurring before 37 weeks gestation (preterm) in the absence of uterine contractions (prelabor). The consequences of PPROM include preterm labor and birth, chorioamnionitis, pulmonary hypoplasia due to severe oligohydramnios, skeletal and joint deformities due to compression, fetal infection, maternal infection. Pulmonary hypoplasia is usually due to severe oligohydramnios. Maternal urinary incontinence is common. If PPROM occurs at <24 weeks gestation and resulted in severe oligohydramnios, infusion of normal saline into the amniotic cavity has been shown to reduce pulmonary hypoplasia. The number of vaginal examinations should be kept to the minimum during labor to reduce infective morbidity. Prophylatic benzylpenicillin or ampicillin is indicated at first presentation and again intrapartum.