It is All in the Smear: An Unusual Cause of Puerperal SepsisBlack, Benjamin Oren MBBS, MSc, MRCOG; Bignall, Jenine Kerry-Anne MBBS, BSc, DRCOG, DFSRH; Gupta, Manish MB, ChB, MRCP, MRCOGInfectious Diseases in Clinical Practice: May 2014 - Volume 22 - Issue 3 - p 177–179 doi: 10.1097/IPC.0b013e31828f4d99 Case Reports Abstract Author Information Abstract: Puerperal sepsis is the leading cause of direct maternal mortality in the United Kingdom. In recent years, efforts have been made to increase awareness and reduce the burden of sepsis in pregnancy. We report the case of a 29-year-old Pakistani lady admitted to a London hospital at 37 + 3 weeks’ gestation with signs of infection and fetal distress. She had an emergency cesarean delivery and was treated for presumed chorioamnionitis. In the early postpartum period, she had a rapid deterioration exhibiting signs of septic shock. As part of her investigations, a blood smear demonstrated Plasmodium vivax parasitemia. Plasmodium falciparum is well documented as causing severe illness in pregnancy, whereas P vivax is often considered a benign form of malaria. The complex manifestation seen in this case reinforces the changing opinion of P vivax and its implications in pregnancy. It is prudent for physicians outside of endemic areas to remain vigilant of imported malaria. From the Whipps Cross University Hospital, London, UK. Correspondence to: Benjamin Oren Black, MBBS, MSc, MRCOG, Maternity Department, Whipps Cross University Hospital, Whipps Cross Road, Leytonstone, London E11 1NR, UK. E-mail: firstname.lastname@example.org. The authors have no funding or conflicts of interest to disclose. © 2014 by Lippincott Williams & Wilkins.