INTRODUCTION

Puerperium is the phase that begins approximately one hour after the delivery of the placenta and lasts for the next six weeks. Puerperal sepsis is an infection that occurs during puerperium due to bacterial invasion of genital organs (Nian Liu. et al,2006).

A recent study has defined puerperal sepsis as a genital tract infection that occurs at any day of postpartum. and the time from membrane rupture or the onset of labor until the 42 days after delivery, Signs and symptoms of puerperal sepsis include arise in body temperature , pelvic pain, irregular vaginal discharge, and sub-involution

(Taleligne Tsfaye. et al,2023).

Puerperium infection is one of many risk factors that can lead to maternal mortality worldwide. "Approximately five million cases of pregnancy-related infection occur every year globally, and approximately about 75,000 result in death" The most common types of Puerperium infections are endometritis (puerperal sepsis), urinary tract infections, blood stream infection and wound infections (Joseph,2018).

The predisposing factors contributing to infections include home birth in unhygienic conditions, low socioeconomic status, poor nutrition, primiparity, anemia, prolonged cases membrane rupture, prolonged labor, multiple vaginal examinations, obstetric procedures held in the uterus and postpartum hemorrhage. Puerperal infection may present as puerperal fever or sepsis, endometritis, wound infection, mastitis, or urinary tract infection (Seyed Mehdi.et al,2015).

As well as, it has been shown that preexisting medical problems, febrile illness or taking antibiotics during 2 weeks before presentation, operative vaginal delivery and cesarean section,

 Additional factors such as ,age, low level of education, doing episiotomy, obesity, and multiparous woman, may be associated with severe puerperal infections (Antony Nicoll.et al, 2012), (Malmir. et al, 2022) . This study was conducted to evaluate woman's practice toward puerperium.

METHOD

Research design: A descriptive analytic study has been conducted pregnant and postpartum woman's girls from January 20th 2021 to April 12th 2021.

Sample of study: A purposive (non-probability) sample which consisted of (100) woman's.

The sample collected according the woman's agreement to participate in the study.

Setting of the study: The sample which collected from maternity hospitals in Baghdad city.

Validity of the Instrument: The validity of the instrument was established through a panel of (9) experts. They were faculty members from College of Nursing University of Baghdad. The experts experience years was 18.33 ± 8.93.

These experts were noted to review the questionnaire format for content relevancy and adequacy. Few recommended modifications were done according to experts' opinions.

Data collection methods: The data has been collected through a questionnaire format through interview with the study sample The questionnaire format is comprised of four parts, Part one: Demographic Characteristics consists of closed-end questions; it was constructed to collect woman's age & education levels

 Part two: Reproductive characteristics consists of closed-end question it was constructed to collect the types of delivery.

Part three: Pattern of Women’s practices regarding postpartum infections consists of closed-end questions; it was constructed to collect woman's practice in temperature monitoring , Not emptying the breast completely while breastfeeding , Doing the correct           position while feeding (placing the nipple only in the (baby’s mouth ,…etc.

Part Four relationship between studied variables and woman's practice of postpartum infections.

Statistical analysis

Data are analyzed through the use Excel (Statistical package) and Descriptive statistic was used to analyze data.

1. Descriptive statistical data analysis:
2. Frequencies & Percentage (%)

                               Frequency 

Percentage %= x 100 

                              Sample size

2. Mean & Standard Deviation

 =  

Where  = the mean

∑ = the sum of

X = each individual raw score

N = the number of cases

SD =

3. Rating & Scoring of the Scale

The part three Pattern of Women’s practices regarding postpartum infections questionnaire items were rates and scored to two items as one for disagree and two for agree, while the numeric values for the negatives items of the scale were 1 for disagree and 2 for agree. 

Cut of point =        =        =   =  

RESULTS

Table (1): Distribution of the Study Sample according to Socio-Demographic Characteristics.

Age of the study sample: The most study sample at age group (31-35) years with mean age and SD is 15.93 ± 1.932

Education level: The highest percentage (29 %) were primary school graduate.

Table (2): Distribution of Reproductive Characteristics for Post Partum Woman's.

shows that the highest percentages (43%) were doing caesarean section.

Table (3): Distribution of Women’s practices regarding postpartum infections.

Using soap when washing the breast (94%), Not completely emptying the bladder during urination(89%), Use of internal douching(88%).

Table(4): relationship between studied variables and women’s practice about postpartum.

Table (4) show there is no significance relationship between studied   Variables and women’s practice about postpartum infections.

 DISCUSSION

The present study reveals that the most common age group in the sample is (31-35) years with mean age and standard deviation of 15.93 ± 1.932, Additionally,(29.0%) of the participants have aPrimary school education level, as shown in table (1). These findings are consistent with the finding which found that the  majority of the patients (37.4%) were between the ages 31–36 years, 12.3% had no formal education (Taiwo, et al,2022).

Another study conducted in Bangladesh on woman with postpartum complications found that the majority of participant within the age range of 26-30 years, constituting 44% of the total (Rahima,et al ,2023).                                                                                                              et al., 2022)

The Reproductive Characteristics:

Section shows that the highest percentages (43%) underwent caesarean section shows in table (2).thia is in agreement with across sectional study conducted in kamala, which reported  a high rate of caesarean section, about 64%and previous scar incidence of (97.6%) (Nantume S. et al, 2023)

Regarding Women’s practices related to postpartum infections.

(94%) reported using soap when washing the breast as shown in table (3) these result conflicted with a study by (Julie S. Moldenhauer , 2022) in Philadelphia, which did not indicate the use soap to treat breast infection.

(89%) reported not completely emptying the bladder during urination as shown in table (3), this finding is agree with a study show that suggested incomplete bladder emptying can cause postpartum urinary retention( Alexandra C, 2023).

(88%) reported the use of internal douching as shown in table (3). which is very close to the findings of a study conducted in Egypt by (Ahmed Alaa, et al, 2023) which concluded that the using of internal douching increases the risk of vaginal infection.

The relationships between Studied Variables and Women’s practice about postpartum infections

About postpartum infection section shows that there is no significant relationship between Studied Variables women’s practice about postpartum infections as shown in table (2).

In the study conducted by (Talelign Tesfaye, et al, 2023) which aimed to identify the  determinants of puerperal sepsis among postpartum women, demographics characteristics were not indicated as significant expect for the cesarean delivery, Per-vaginal Examination ≥5 times during labor, manual removal of placenta.

 CONCLUSIONS

The study concluded that the highest percentage of responses from the study group were low for items related to women’s practices about postpartum infectionsand, and there is no significance relationship between studied   variables and women’s practice regarding postpartum infections.

RECOMMENDATION

The study recommended educating women on the correct practices to prevent postpartum infections, conducting studies with an educational program on postpartum infections, and providing educational lectures and guidance programs on postpartum infections (definition, causes, prevention).

Ethical Approval Statement

This research study, titled " Evaluation of Woman's Practice aboutPuerperal Infection in Baghdad City

" conducted by [Alyaa Khazaal Neamah], has received ethical approval from the [Nursing College ethical committee] at [University of Baghdad]. The woman were informed about the research’s purpose and ensured anonymity and confidentiality of the information. A written informed, consent for voluntary participation consent was obtained from each participant.

FUNDING
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.

 AUTHOR’S CONTRIBUTIONS

All authors contributed equally to the conception and design of the study, data collection, and analysis, and drafted the initial manuscript. All authors critically reviewed and edited the manuscript. All authors approved the final version of the manuscript for submission.

DISCLOSURE STATEMENT
The authors report no conflict of interest.
ACKNOWLEDGEMENTS
We thank the anonymous referees for their useful suggestions.