Purpose: To determine the microbial etiology and evaluate maternal and fetal outcomes associated with preterm premature rupture of membranes (PPROM) in patients presenting to the labor room at Saraswati Medical College between 2017 and 2019. Methods: A retrospective observational study was conducted on antenatal patients with PPROM between 28 and 37 weeks gestation. Maternal records, microbiological culture results, and perinatal outcomes were analyzed. Vaginal and cervical swabs were cultured to identify causative organisms. Results: Out of 1,260 deliveries, 126 cases (10%) were diagnosed with PPROM. The most common organisms isolated were Escherichia coli (26.1%), Streptococcus agalactiae (19.8%), Klebsiella pneumoniae (14.2%), and Gardnerella vaginalis (12.6%). Maternal complications included chorioamnionitis (9.5%), puerperal sepsis (7.9%), and placental abruption (4.7%). Neonatal complications included low birth weight (43.6%), respiratory distress syndrome (28.6%), neonatal sepsis (22.2%), and NICU admissions (38.9%). Conclusion: PPROM poses significant risk for both maternal and neonatal morbidity, with a distinct microbial profile. Early diagnosis and culture-guided antibiotic therapy can improve outcomes.