We describe two patients with life-threatening puerperal infection due to group A beta-hemolytic streptococcus. Each patient had bacteremia, shock, and multi-organ involvement. Both cases were compatible with a recently described streptococcal toxic shock-like illness. Both women failed to improve despite vigorous medical and antibiotic therapies, and each required hysterectomy. Obstetricians should be alert to the importance of early diagnosis and treatment of this potentially lethal infection.