Background: Preterm rupture of membranes (PROM) affects 3% of pregnancies, with 0.4% experiencing second-trimester ROM. Gestational age at PROM strongly influences outcomes. Neonatal survival rates vary by gestational age. Short latency (<48 hours) after viability (>24 weeks) is associated with adverse outcomes. Objectives: Analyze maternal and neonatal outcomes in patients with previable rupture of membranes (PPROM) between 20-28 weeks of pregnancy. Patients and methods: Retrospective study at Qena University Hospital (June 2020-June 2022) on singleton pregnancies with PPROM. Inclusion criteria: no active labor, chorioamnionitis, fetal anomalies, iatrogenic ROM, or multiple gestations. Data collected: maternal demographics, obstetric history, gestational age at ROM, delivery, interventions; neonatal data including birth weight, Apgar scores, NICU admission, diagnoses, survival. Results: The mean age 26.72 ± 5.51 years and BMI 25.18 ± 4.44 kg/m^2, with 9.38% underweight, 37.5% normal weight, 34.38% overweight, and 18.75% obese. The average gravidity was 3 with a range of 0-8. Parity averaged 2 with a range of 0-7. The mean number of abortions was 1 with a range of 0-5, with 26.56% history of preterm labor. Maternal complications included chorioamnionitis (12.5%), sepsis (4.69%), and cord prolapse (7.81%). Neonatal viability was 67.19%. Among viable fetuses (N = 43), Apgar scores (1 min: 6.7 ± 2.32, 5 min: 7.07 ± 2.45), NICU admission (62.79%, stay: 8.01 ± 5.94 days), and NICU survival (37.21%, N = 35), with 74.42% overall viability. Conclusion: Challenges in early preterm births highlight the need for tailored care. Adverse neonatal outcomes underscore the necessity of targeted strategies for this vulnerable population.