Placental abruption, a leading cause of perinatal morbidity and mortality, results from a cascade of physiological processes that eventually lead to placental separation. Preterm premature rupture of membranes (PPROM) is a known complication of abruption and vice versa. The management of PPROM patients with co-existing abruption is controversial with most advocating expectant management, especially in cases of extreme prematurity and a hemodynamically stable mother. Patients with a diagnosis of chronic abruption are at risk for a unique phenomenon known as chronic abruption-oligohydramnios sequence (CAOS). Women present with chronic vaginal bleeding and oligohydramnios. The subchorionic clot lyses and releases serum, which is interpreted by the patient as a “gush of fluid”. Fluid is nitrazine positive but fern negative. This may erroneously be interpreted as PPROM when in fact membranes are intact. Blood supply and nutrition to the weakens the amniotic sac which may lead to PPROM. The pathophysiology of oligohydramnios is unclear, but may be a consequence of placental insufficiency leading to decreased fetal renal perfusion. HC was a 28-year-old G1P0 who presented at 15 weeks gestation with vaginal bleeding. Ultrasound demonstrated normal amniotic fluid volume, no evidence of placenta previa, and a subchorionic hemorrhage. HC was placed on bedrest. At 17 weeks, ultrasound showed evidence of a chronic abruption and normal fluid. At the 22 weeks prenatal visit, sterile speculum examination (SSE) revealed a small amount of old blood with no ferning or pooling. Ultrasound was significant for an amniotic fluid index (AFI) of 6.3 (oligohydramnios). At 23 weeks gestation, HC complained of blood tinged fluid and uterine cramping. Ultrasound showed severe oligohydramnios (AFI= 4.4). SSE revealed a pool of blood-tinged fluid with valsalva confirming a diagnosis of PPROM. HC was counseled on the ramifications of PPROM at 23 weeks including risk for pulmonary hypoplasia, infection, worsening abruption, and stillbirth. The patient elected to have outpatient expectant management until 26 weeks gestation. One week later, she presented to L&D with complaints of painful contractions. The cervix was visually 1 cm dilated with a small amount of pooling bloody fluid. Steroids, latency antibiotics, and tocolytics were started per the patient's request after intensive counseling. Over the course of 25 hours the patient was on continuous fetal monitoring. The tracing was reassuring for a preterm infant with minimal to moderate variability and occasional variable decelerations. Shortly before delivery, the tracing showed worsening variable decelerations. A male infant was delivered vaginally with Apgars of 1 and 3. The infant subsequently died from complications related to severe prematurity. Nursing plays an important role in the clinical situation complicated by CAOS and PPROM where perinatal and neonatal complications are widespread. We have an opportunity to interface in a manner that provides emotional support as well as clinical expertise at the bedside. Using the most current literature, this case study will highlight the following: maternal and fetal assessment; in-hospital management to allow for early identification of infection, labor, increased bleeding and nonreassuring FHR patterns; administration of steroids, antibiotics, and tocolytics; patient education and psychosocial support.