BackgroundPregnancy management is difficult when pelvic organ prolapse already exists. During pregnancy, childbirth, and the days following, clinicians may come across situations that present management dilemmas. Here, we present conservative management of preexisting pelvic organ prolapse in pregnancy complicated with preterm premature rupture of membrane up to term.Case presentationA 35-year-old Ethiopian woman, gravida V, para IV, visited our emergency obstetrics and gynecology department at 32 weeks and 1 day of pregnancy in a prolapsed uterus on the 4th of April 2022. She was referred from primary hospital as a case of preterm pregnancy, pelvic organ prolapse, and preterm premature rupture of membrane after she presented with complaints of passage of clear liquor of 10 hours duration. She was successfully managed conservatively without application of pessary until she gave birth to a 3200 g healthy male neonate by elective cesarean section at 37 weeks of gestational age. At the same operation, cesarean hysterectomy was done.ConclusionWomen with preexisting pelvic organ prolapse complicated by premature rupture of membrane during the third trimester of pregnancy can be treated without the use of a pessary. Our case shows the importance of conservative management, which includes strict antenatal follow-ups, lifestyle modifications, and manual uterine reduction. Due to potential intrapartum problems from induction of labor with the occurrence of severe pelvic organ prolapse, we recommend cesarean delivery. However, to determine the optimal mode of delivery, additional comprehensive study with a large sample size is vital. If definitive management is warranted after delivery, we need to take a consideration of the status of prolapse, patient’s choice, and family size.