What is ihcp

Most IHCP members receive services through the managed care delivery system. Each MCE maintains its own provider network, provider services unit, and member services unit for the health plans they offer.

The MCE authorizes services, pays claims, and is responsible for subrogation activities. Still can't find the acronym definition you were looking for? Use our Power Search technology to look for more unique definitions from across the web! Search the web. Citation Use the citation options below to add these abbreviations to your bibliography.

Powered by CITE. Asymmetric Directory Subscription Line. Analog Directory Super Line. Alternative Digit Serial Line. Asymmetric Digital Subscriber Line. But what makes this entity particularly deserving for a timely diagnosis and intervention are the dreaded fetal outcomes like pre-term delivery, meconium staining of amniotic fluid, fetal bradycardia, fetal distress and, the most unfortunate, fetal loss. The terms pruritus gravidarum and IHCP have been used interchangeably in the literature but pruritus gravidarum essentially means pruritus without any skin lesion that occurs in the first trimester of pregnancy.

The incidence of IHCP varies from 0. The etiology of IHCP is not clear but it is believed to be multifactorial with genetic, environmental and hormonal factors being involved. Occurrence in third trimester and higher incidence in twin pregnancies with a higher estrogen level than single gestations, speak in favor of estrogen theory. ICHP usually presents in the third trimester in most cases but rarely presentation as early as 6 to 10 weeks have also been described.

The severity of itching can be mild to severe enough to cause sleep deprivation, psychological suffering and even suicidal thoughts in the mother. Pruritus is most severe in the evenings with a predilection for the palms and soles, although it may be widespread and associated with malaise.

Secondary skin lesions like excoriation marks may be observed, narrating a pruritic tale. Malabsorption of fat secondary to cholestasis can lead to steatorrhea, weight loss and vitamin K deficiency with coagulopathy in severe cases. For a diagnosis of IHCP to be established, there must be no history of exposure to hepatitis viruses or hepatotoxic drugs or past history of liver or gall bladder diseases.

Coagulation studies may reveal prolonged prothrombin time reflecting vitamin K deficiency. The pathogenesis of fetal complications is still poorly understood, although a role of bile acids and toxic metabolites of bile acids which can induce contraction of chorionic veins of placenta have been hypothesized.

Apart from the distressing pruritus, prolonged and severe IHCP can cause coagulopathies due to vitamin K deficiency, which can result in post-partum hemorrhage in mothers. The primary objective of pharmacological treatment of IHCP is to alleviate maternal symptoms and improve fetal outcome.

The pruritus associated with mild cholestasis responds to bland anti pruritic emollients, soothing baths, primrose oil and topical anti-pruritics. Increased water intake and a low fat diet can be beneficial. The most efficacious, current medical management that improves maternal condition and might prevent perinatal complications of IHCP, is ursodeoxycholic acid UDCA. Relief usually occurs within one to two weeks.

Although the mechanism of action is not fully understood, it is postulated that UDCA works by displacing hydrophobic endogenous bile salts from the bile acid pool, and protects hepatocytes from their toxic effects and enhances bile acid clearance across placenta from the fetus.

None of these above mentioned pharmacotherapy has definitive protective role when it comes to preventing adverse fetal outcomes. Hence it is advisable to aim at delivering the fetus between 37 to 38 weeks of gestation or even earlier as soon as fetal lung maturity is attained if there is sufficient risk of maternal morbidity or fetal compromise detected. Intra-hepatic cholestasis of pregnancy is a common pregnancy dermatosis that usually presents in third trimester of pregnancy with pruritus, without any primary skin lesions.

Biochemically, the condition is characterized by increased SBA and aminotransferases, with or without increased serum bilirubin. Though it is a benign condition in the mother, in the fetus it can be responsible for adverse outcomes like pre-term delivery, fetal distress to even fetal loss.

Various studies have shown ursodeoxycholic acid as the most effective treatment of IHCP, which improves maternal condition and probably even prevents perinatal complications. Apart from timely diagnosis and treatment frequent fetal surveillance is strongly urged, aiming at an early delivery once fetal lung maturity is attained. Ursedeoxycholic acid is the most efficacious medical treatment available for IHCP, but has no definitive role in preventing adverse fetal outcome. It is advisable to aim at delivering the fetus between weeks of gestation or even earlier as soon as fetal lung maturity is attained if there is sufficient risk of maternal morbidity or fetal compromise is detected.

Source of Support: Nil. Conflict of Interest: Nil. National Center for Biotechnology Information , U. Journal List Indian J Dermatol v. Keystage 4 Co-ordin. Lecturer Librarian Managing Director Market. Download EduCare's newsletter. Schools and early years settings must have a policy and procedures in place for the administration of medication to children and young people. This course contains statutory and non-statutory guidance on the operation of such a system and the responsibilities of staff and parents.

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