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Vagal reactions Mild: diaphoresis, nausea Moderate: dizzy, lightheaded, low HR +/- BP Severe: loss of consciousness, seizure Perforation at time of insertion By sound or IUD Infection Greatest in first 20 days (consider prophylaxis) Expulsion 2-5% in first year of use No need to do anything – they resolve without sequelae Atropine 0.6mg IV works like magic If you take the IUD out, expect rapid healing without sequelae Copper IUDs in the abdominal cavity cause scarring and should be removed laparoscopically Consider prophylaxis in high risk women (metronidazole 2 g or doxycycline 300 mg) Consider treatment does (one week of doxycycline) in very high risk women