Our objective was to determine the rate of spontaneous version following preterm premature rupture of membranes (PPROM). Medical charts over a 4-year period were reviewed. All women with PPROM and singleton gestation between 24 and 34 weeks gestation were included; 65 patients met the inclusion criteria. By ultrasound on admission, 48 were cephalic 16 were breech, and one was transverse lie. Mean amniotic fluid index on admission was 5.1 +/- 4.8 cm (standard deviation) and was not associated with fetal presentation at delivery. Spontaneous version from cephalic presentation at admission to noncephalic presentation at delivery occurred in one pregnancy (2.2%). Spontaneous version from noncephalic presentation at admission to cephalic presentation at delivery occurred in three pregnancies (17.6%; p = 0.05). Among women with noncephalic presentation at delivery (n = 15), 73.3% had a cesarean, compared with 23.4% of those with cephalic presentation at delivery (p < 0.05). Spontaneous version, particularly from cephalic to noncephalic presentation, is unlikely following PPROM.