OBJECTIVE: To assess the different presentations of pyomyoma in pregnant and postpartum populations, and review the treatment modalities. DATA SOURCES: This systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We performed a comprehensive search of PubMed, Scopus, Google Scholar and Embase during the years 1945 to October 2024. STUDY SELECTION: Included case reports assessed the types of intervention (hysterectomy, myomectomy, or other forms of treatments) to treat Pyomyoma. All case studies confirming a diagnosis of pyomyoma on either operative and/or histological findings were eligible. A total of 123 studies were initially screened and after a full-text evaluation, 40 articles with a total of 43 cases were included in this systematic review. DATA EXTRACTION AND SYNTHESIS: Pyrexia and abdominal pain were the most common presenting symptoms found in 79% and 77% of patients, respectively. The most common causative organism was E-Coli (23%). Hysterectomy was performed in a total of 13 (30%) patients, myomectomy in 24 (56%) patients and 6 (14%) patients were treated conservatively. CONCLUSIONS: Given the considerable morbidity associated with pyomyoma, the benefits of surgical treatment tend to outweigh the potential risks. However, since pregnant and postpartum women are a younger cohort and fertility is a concern, myomectomy is preferred to hysterectomy.