A 30-year-old woman, originally from Romania, was admitted to the Delivery Suite of our unit as a transfer from a neighbouring trust with a history of preterm premature rupture of membranes (PPROM) and low lying placenta at 29 weeks. She had had one previous miscarriage at 8 weeks and one previous caesarean section for breech presentation at 40 weeks whilst resident in Romania. Otherwise she had no previous medical history of note. In the UK, she had previously been admitted twice to her booking hospital for vaginal bleeding at around 25 weeks, at which time she was given two doses of steroids. She then ruptured her membranes at 28 weeks and 5 days. An ultrasound scan (USS) showed oligohydramnios, anterior low lying placenta, normal growth (EFW 1,350 g) and breech presentation. She was transferred to our unit in view of the risk of early delivery. Although initially stable, the patient required a grade 2 emergency caesarean section at 29 weeks and 3 days for a rising CRP and suspected chorioamnionitis. The caesarean section was uneventful. She received our routine antibiotic prophylaxis with a single dose of cefuroxime (1.5 g) and metronidazole (500 mg) at the time of surgery and she recovered well, being discharged 2 days later. The baby was admitted to our Neonatal Unit for management of prematurity and suspected infection. The second day following discharge she attended our Accident and Emergency Department complaining of fever, generalised abdominal pain and distension. She had no urinary or bowel symptoms. On examination, her temperature was 37.4°C with a tachycardia of 121 bpm; the examination was otherwise unremarkable and the caesarean scar was clean and dry. Her blood tests showed a raised white cell count at 21 £ 10/L (reference range 3.5–9 £ 10/L), neutrophils 17.6 £ 10/L (reference range 1.3–5.4 £ 10/L) and CRP of 476 mg/L (reference range <5 mg/L). She was admitted to the maternity ward for close observation with an initial diagnosis of sepsis of unknown source and intravenous cefuroxime (1.5 g three times daily) and metronidazole (500 mg three times daily) were started, along with pain relief. The following day her temperature was 38.5°C with worsening abdominal distension and clinical examination revealed rebound tenderness. The CRP was found to be 573 mg/L. Blood cultures were taken. On day 2 post-admission, the patient continued to show no signs of improvement and developed a large area of erythema around the scar site up to the navel, with induration of the skin. A transabdominal U/S was performed by the Consultant in the ward. This showed a large collection (174 £ 100 £ 62 mm), likely to be intraabdominal in origin. Given the suspicion of the above, a CT scan of the abdomen and pelvis was ordered. Free Xuid was noted in the abdomen and pelvis along with generalised oedema of the intraabdominal fat consistent with secondary signs of sepsis. However, no collection was seen. J. Melendez (&) · A. Claxton · K. Erskine Homerton University Hospital, Homerton Row, London E9 6SR, UK e-mail: joan.melendez@gmail.com