Abstract Objective: To evaluate the intensity of the fetal inflammatory response, characterized by umbilical cord blood IL-6 levels, and neonatal outcome in the preterm prelabor rupture of membrane (PPROM) pregnancies using the pulsatile fetal splenic vein flow pattern. Methods: Women with singleton pregnancies complicated by PPROM at a gestational age between 24+0 and 36+6 weeks were included in the study. Doppler evaluation of the fetal splenic vein flow was performed. The flow-velocity waveform pattern was evaluated qualitatively as continuous or pulsatile. The umbilical cord blood interleukin-6 (IL-6) levels were evaluated after delivery. The fetal inflammatory response was defined as IL-6 > 11 pg/mL. Results: In total, 129 women were included. The fetuses with pulsatile splenic vein flow exhibited higher IL-6 levels in umbilical cord blood (median: 56.7 pg/mL vs. 5.6 pg/mL; p<0.0001) and had a higher rate of fetal inflammatory response syndrome (71% vs. 35%; p=0.0005) than fetuses with continuous flow. The pulsatile flow pattern was related to a higher rate of early onset neonatal sepsis (odds ratio 4.2; 95% confidence interval: 1.3-13.5). Conclusion: The presence of pulsatile fetal splenic vein flow in PPROM pregnancies is associated with fetal inflammatory response and neonatal morbidity.