Prelabor rupture of membranes (PROM) and preterm labor are challenging obstetric complications for any emergency physician. In the United States, preterm delivery complicates approximately one in ten births and is a significant contributor to perinatal morbidity and mortality. Although the causes are often unknown, emergency physicians should be familiar with predisposing risk factors. The rate of fetal and maternal morbidity can be reduced with accurate diagnosis of PROM, preterm labor, intervention to delay preterm delivery, timely administration of corticosteroids, and, in certain cases, magnesium sulfate and antibiotics. When preterm PROM occurs, several complications can result including infection, premature delivery, placental abruption, and umbilical cord prolapse. The initial emergency department management involves an exam, obstetric ultrasound, labs, and cultures as indicated. Fetal malpresentations should be anticipated in the setting of preterm PROM with preterm labor. Considerations should be given immediately to transport to a tertiary care center with neonatal intensive care unit, especially if less than 34 weeks gestational age. Contraindications to transport include imminent delivery, fetal or maternal distress or unstable status, or if there is no safe transport to a referral center.