Background : Early premature rupture of membranes (PPROM) before foetal viability complicates obstetric treatment, putting women at risk of infection, haemorrhage, and psychological anguish and newborns at danger of respiratory distress Gestational age, cervical dilatation, nulliparity, foetal development difficulties, oligohydramnios, twin gestation, and chorioamnionitis impact PPROM delay post-viability. 
Aim: To analyze maternal and neonatal outcomes in PPROM cases between 20-28 weeks of pregnancy to identify potential outcome predictors. 
Methods : Qena University Hospital's retrospective observational cohort research (June 2020–June 2023 ) comprised singleton PPROM pregnancies between 20–28 weeks. Active labour, chorioamnionitis, foetal abnormalities, recent iatrogenic ROM, multiple gestations, and immediate delivery are excluded. Maternal demographics, obstetric history, treatments (antibiotics, glucocorticoids, magnesium sulphate), and neonatal outcomes (birth weight, Apgar scores, NICU admissions, pulmonary issues, intraventricular haemorrhage, periventricular leukomalacia, necrotizing enterocolitis, and sepsis.
Results: Of the participants (mean age 27.39 years, BMI 25.07 kg/m²), 39.02% were normal weight, 34.15% overweight, and 18.29% obese Diabetes or hypertension was present in 7.32%, PROM in 24.39%, and premature labour in 30.49%. The mean ROM gestational age was 24.93 weeks, with birth in 30.11 weeks. Caesarean delivery 48.78%, vaginal 51.22%. Non-viable pregnancies had earlier ROM and delivery ages, higher Caesarean rates, and more chorioamnionitis and maternal sepsis. Neonatal survivors had higher Apgar scores, birth weights, and pulmonary hypoplasia and sepsis rates than non-survivors. 
Conclusion: Early premature deliveries make PPROM management difficult. Variations in medical procedures need customised care. NICU-admitted newborns have poor neonatal outcomes, requiring tailored care and outcomes initiatives.