Pyomyoma is a rare, yet potentially fatal complication of uterine leiomyoma. Clinically difficult to diagnose as a result of non-specific symptoms, its presentation is commonly confused with fibroid degeneration. Late diagnosis has severe implications, with the mortality of the condition remaining high. Despite the availability of powerful antibiotics, surgical intervention is frequently required for the curative treatment of the critically ill patient. Here, we report a case of postpartum pyomyoma developing after a complicated antenatal course of placenta praevia resulting in recurrent antepartum haemorrhage, preterm prelabour rupture of membranes and eventual emergency caesarean section for cord prolapse. We highlight the diagnostic difficulty and delay in definitive surgical intervention. Using this case, we have emphasised the importance of strong clinical suspicion when faced with a triad of pain, sepsis without an obvious source and a known diagnosis of leiomyoma to prevent fatalities.

vs. 0.7cm), the length of the implanting part of gestational mass in the lower segment (3.3cm vs. 1.2cm), the minimum thickness of remaining lower uterine myometrium (0.08cm vs. 0.20cm), the lower segment protrusion rate (60% vs. 5.7%), the fetus CRL (1.7cm vs. 0.7cm) and the CDFI grading were significantly different between case and control group. As for clinical prognosis, the patients of case group experienced higher ratio of CSP lesion resection under open surgery or laparoscopy (35% vs. 2.86%), more blood loss in surgery (35ml vs. 20ml) and more hospitalisation days (7.5d vs. 3.5d) than control group. Conclusions: Lacunar-like change of chorion can be detected in early gestation, the sonography and clinics were different between case and control group, it is a predictor of worse clinical outcome.