A Letter from Dr. Mosier

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Dear Patients,
It is with mixed emotions that I announce my departure from Advanced Ob-Gyn Associates (AOA), effective September 14, 2019. It has been a pleasure providing for your health care needs over my time here, and it is not easy for me to give it up. I have made the decision to return to my home town, Houston, Texas to be close to family members.

I am hoping that you will be able to remain with my group and become a patient of one of our fine doctors at AOA. Dr. Richard Salter and Dr. Anu Gupta are very experienced and caring physicians who would be an excellent choice for continuing your care. It is my understanding the practice will be acquiring another female physician in the very near future.

I am happy to have left my patients in these capable hands. However, you may seek care from another doctor if you would like. If you choose to do so, I recommend looking for a new physician as soon as possible. Assistance can be obtained from the Dallas County Medical Society; they can help by giving you the names of doctors in the area who are accepting new patients.

Your medical records are confidential and a copy can be transferred to another doctor or released to you or to another person you designate only with your permission. If you plan to continue with this office, this step is easy. You can sign an authorization to release your files on your next visit. If you choose to see a different physician outside of this office, please contact us so that arrangements can be made for transfer of your records (there will be a fee for this depending on circumstances). Your records will continue to be on file at the AOA office.

I have valued your relationship greatly. Thank you for your loyalty and friendship during my time at AOA. Best wishes for your future health.

Elizabeth Mosier, M.D.

Debunking the Myths in Pregnancy

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MYTH 1. You should be eating for two

Pregnant women were told to eat for two in the past. However, it is important in finding a balance between getting enough nutrients to fuel the baby’s growth and maintaining a healthy weight. A pregnant woman who has a body mass index (BMI) in the normal range before pregnancy needs, on average, only about 300 extra calories a day—the amount in a glass of skim milk and half a sandwich. If you are pregnant with twins, you’ll need 600 extra calories per day. Also, it’s important to taking a prenatal vitamin every day.

MYTH 2. Say good bye to eating fish

Fish is an excellent source of omega-3 fatty acids. There is strong scientific evidence to suggest that these fats are important in the development of the fetal nervous system.  To gain these benefits, women who are or who may become pregnant or who are breastfeeding should eat at least 8 ounces and up to 12 ounces (about two to three servings) of fish per week. Some types of fish have higher levels of metal called mercury than others. Mercury has been linked to birth defects. Choose fish that are lower in mercury, such as shrimp, salmon, cat fish, canned light tuna and sardines. Do not eat shark, sword fish, king mackerel, or tile fish, which have the highest levels of mercury.

MYTH 3. Skip your coffee

If you have been told to skip your morning cup of coffee, as it increases risk of preterm delivery, miscarriage or low birth weight, we have good news for you. Most experts believe that consuming less than 200 mg of caffeine a day during pregnancy is safe-i.e. one 12-ounce cup of coffee.

Although, caffeine is also found in tea, soda, and chocolate, makes sure you count these sources in your total caffeine for the day, when you enjoy your daily java.

MYTH 4.Say no to sex

Sex is safe when you are pregnant, unless you have certain conditions like placenta Previa, history of preterm delivery, etc. Sex doesn’t hurt the baby as it is protected by the amniotic sac.

MYTH 5.Forget your much awaited vacation

For most women, traveling during pregnancy is safe. As long as you and your fetus are healthy, you can travel safely until you are 36 weeks pregnant. Although the best time to travel is between 14- 28 weeks. Travel is not recommended if you have certain pregnancy complications, including preeclampsia, multiple pregnancy, premature rupture of membranes, and preterm labor. Also avoid traveling to areas where Zika outbreaks are ongoing. Zika is an illness spread by mosquitoes that can cause serious birth defects. Also it’s pretty normal, if you worry about airport body scanners-ray machines, etc. It’s a very small amount of radiation and very unlikely to cause any fetal effects.

MYTH 6.Don’t exercise when you are pregnant

If your pregnancy is normal, it is safe to continue or start most types of exercise. Physical activity does not increase your risk of miscarriage, low birth weight, or early delivery. Exercise during pregnancy benefits you and your baby -reduces back pain, decrease your risk of diabetes, preeclampsia, and cesarean delivery

Pregnant women can do at least 150 minutes of moderate-intensity aerobic activity every week or you can divide the 150 minutes into 30-minute workouts on 5 days of the week or into smaller 10-minute workouts throughout each day. Aim at targeting heart rate below 140 bpm

If you are new to exercise, start out slowly and gradually increase your activity. Begin with as little as 5 minutes a day. Add 5 minutes each week until you can stay active for 30 minutes a day.

If you were very active before pregnancy, you can keep doing the same workouts with your health care professional’s approval. However, if you start to lose weight, you may need to increase the number of calories that you eat.

MYTH 7 Don’t cross your legs or reach above your head-it will cause the umbilical cord to wrap around baby’s neck

The umbilical cord will not be affected by your body position or activity. The fetus moves in amniotic fluid and cord can be wrapped around any part of the baby. Most times, it will not cause a problem in labor and delivery unless the cord is unusually short or tight around the body or if there is a decreased amount of fluid. Most deliveries occur and the cord around a body part is an incidental finding as it causes no problems with delivery.

I am perfectly healthy; do I still need a well woman exam every year…?

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This is a very common concern women have. But having an annual gynecological exam is an important aspect of responsible preventive health care and ensuring physical and reproductive wellbeing.  Many women think they do not need a physician unless they have a problem. In fact, problems are often first found through an annual exam. Every woman should be aware that diseases such as breast, cervical and ovarian cancer have few obvious symptoms, and earlier detection improves chances of survival. It is important women get annual exam done because it is the time when we not only perform a complete history and physical exam, but also a time when screening tests are ordered, immunizations are given and lifestyle habits are discussed.

Why annual exams are important?

1. BEYOND PAP– Contrary to the belief, the annual exam is not just a pap and breast exam.

– Vaccines: Age and season appropriate vaccines may also be offered during the visit, including human papillomavirus, tetanus boosters, Hepatitis B and flu.

Questions: You should ask any questions about pregnancy, hormones, your menstrual cycle, menopause symptoms and other general health issues.

  Screening tests for osteoporosis, colon cancer and diabetes. Other issues such as birth control methods or preconception counseling, protection from STDs, calcium intake requirements, the need for cholesterol screening, and the importance of regular exercise and eating a well-balanced diet. We can also offer help on smoking cessation.

2. Know your OB/GYN: You will feel more comfortable, if and when you require further treatment, are ready to have a baby or go through other significant life changes.

3. GETTING PAST THE DR. INTERNET: It is very common to feel confused and develop myths after reading so much on internet. But at your annual exam you will get a chance to ask questions and get evidence based answers which will help you make informed decisions regarding your health.

When should the annual exam start?

Annual gynecological exams should begin around age 15. While pelvic exams are rarely required during these first visits, the annual exam helps to establish a doctor-patient relationship. Young women can ask any questions they have about their development and/ or menstrual cycle, methods of birth control and how to protect against sexually transmitted diseases. Most doctors now recommend an annual Pap smear for most women ages 21 and older.

I already had a hysterectomy or I am not sexually active, do I still need the annual exam?

Many women have equated having a Pap smear with having an annual exam when in fact a Pap smear is only a small component of the visit. Women should have a gynecological exam every year whether or not they are due for or need a Pap smear.

What should you expect at your exam?

First, a comprehensive medical history is taken, including a family history to assess possible familial cancer risks. A physical exam is performed, including an assessment of blood pressure, height and weight, a pelvic and breast exam. During the pelvic exam the doctor may do a Pap smear, then check internally to examine the uterus and ovaries. Your doctor will also order a screening mammogram if you are 40 or older. Patients of all ages will be taught to perform monthly self-breast exams. These steps are essential in helping to detect breast cancer. Your doctor will discuss birth control methods or preconception counseling, protection from STDs, calcium intake requirements, the need for cholesterol screening, and the importance of regular exercise and eating a well-balanced diet. They can also offer help on smoking cessation. If you are postmenopausal or otherwise at risk, your doctor will recommend screening tests for osteoporosis, colon cancer and diabetes. Vaccines may also be offered during the annual visit, including human papillomavirus, tetanus boosters, Hepatitis B and flu. You should ask your doctor any questions you have about pregnancy, hormones, your menstrual cycle, menopause symptoms and other 

Who performs the exam and who will be in the room with me?

Your ob gyn doctor or the nurse practitioner will perform the exam. Customarily your doctor and the medical assistant will be in the room.

Vaginal Birth After Cesarean Delivery (VBAC)

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Choosing a vaginal delivery after a C-section can be a safe and appropriate choice for many women. Studies have shown up to a 60-80% success rate for women who attempt VBAC. However, it is a very personal decision, as neither VBAC or repeat C-section are 100% free of risk or complications. It is very important for all patients considering a VBAC to carefully weigh the risks and benefits.

VBAC is recommended by the American College of Obstetricians and Gynecologists. More information can be found here: http://www.acog.org/Patients/FAQs/Vaginal-Birth-After-Cesarean-Delivery-Deciding-on-a-Trial-of-Labor-After-Cesarean-Delivery.

Who is a good candidate to attempt a VBAC?

A patient who has had 1 prior vaginal delivery with a normal incision on the uterus (side to side, or “low transverse”) is a good candidate for VBAC. Your prior hospital records will be used to confirm the location of the uterine incision, as your scar on your abdomen frequently may not be the same as the scar on the uterus.

Who is not a good candidate for VBAC?

Any of these complications may increase the risk of uterine rupture:

  • History of multiple C-sections
  • Vertical or “classical” incision on the uterus
  • Medical complications including but not limited to diabetes, hypertension, preeclampsia

What are the benefits of VBAC?

Your future plans for more children may impact your decision. Because C-sections become more risky with each subsequent surgery, you may want to consider VBAC if you plan to have a large family. Other benefits include:

  • Avoiding major surgery
  • Decreased recuperation time and hospital stay
  • Decreased risk of blood loss or infection

What are the risks of VBAC?

The main risk of VBAC is a small risk of uterine rupture or a tear in the wall of the uterus. This happens in less than 1% of appropriately selected patients. If uterine rupture were to occur there is an increased risk of:

  • Emergency C-section
  • Blood transfusion
  • Hysterectomy
  • Fetal injury or stillbirth

What are the risks of repeat C-section?

  • Increased risk of blood loss, infection, injury to adjacent organs
  • Abnormal implantation of the placenta requiring preterm birth, blood transfusion, or hysterectomy
  • Increased recuperation time and hospital stay

You can use the Maternal-Fetal Medicine Unit Network Calculator to see your own calculated success rate based on age, BMI, and other prior history: https://mfmunetwork.bsc.gwu.edu/PublicBSC/MFMU/VGBirthCalc/vagbirth.html. Evidence suggests that women with at least a 60–70% chance of successful VBAC have less risks for VBAC vs. C-section. However if your chance of success is less than 60%, the risks of VBAC may outweigh the benefits.

What increases my success rate?

  • Prior vaginal delivery or VBAC
  • Spontaneous labor
  • Age less than 35
  • Prior C-section for breech position or fetal distress

What decreases my success rate?

  • Need for induction
  • Delivery after 40 weeks gestation
  • Age over 35
  • Obesity
  • Prior C-section for failed induction
  • History of large baby or current large baby
  • Patients who delivered prior baby less than 1 year ago

Please discuss VBAC with your doctor during your visit. Your doctor will help you evaluate your personal risk and chance of success and guide you though the process. If you and your doctor decide to attempt a VBAC, it is important for all patients to realize that your health and your baby’s health is the most important priority to all the physicians at Advanced Ob-Gyn Associates. While we want to provide every patient with their desired birth experience, all patients must be prepared to make changes as necessary to keep them safe. 

Best OBGYN in Dallas

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The best OBGYN in Dallas TX

Why is Advanced OB GYN the best choice for me?

Turn to Advanced OB GYN Associates of Dallas for their reputation as one of the best practices in the Dallas area. The best Dallas gynecologists are waiting for you at AOA.

When looking for your first gynecologist or a new one, trust the professional physicians at AOA to ensure you are treated with care and respect.

Expert Obstetricians

At AOA the best Dallas OB GYN’s are available to help you through some of the most difficult times in your life, from puberty to child bearing to menopause; our caring Obstetricians and Gynecologists can the answers you are looking for.

Cutting Edge Technology at Advanced OBGYN

AOA is not only known for our caring staff. With cutting edge, minimally invasive robotic surgery among the many options available at the clinic, you can be assured that you have the most effective options available to you. With leading procedures in cervical cancer screening, infertility, 4D sonographic imaging, the Leep procedure and even heavy period solutions, our team is backed by some of the best technology in the field today.

Best Dallas Gynecologists

With leading OB-GYNs serving the Dallas area you can be assured of a caring solution that goes above and beyond a “traditional” doctor visit. Meet our team of professionals:

Dr. Richard Salter is one of the most well-known OB-GYNs in the Dallas area as seen frequently on Dallas News stations and on the popular “Top Docs of DFW.” With experience spanning two decades Dr. Salter is the resident expert for high risk obstetrics, infertility assessment and treatment and early stage gynecologic cancer surgery.

Total Care Solutions for women

Whether you are looking for solutions for infertility, common gynecologic maladies or worried about cervical cancer, our full team of the best Dallas Gynecologists have all your bases covered.

Come visit the best, come visit Advanced OB-GYN & Associates in Dallas for your OB-GYN needs today.

After Tubal Ligation

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After Tubal Ligation

After Tubal Ligation Surgery: Symptoms and Side Effects

There are many reasons that a woman may choose not to have children or not to have any further children. Regardless of the reason, tubal ligation surgery is usually the answer to resolve this very personal decision. Although, this type of surgery is not considered to be life-threatening; there are some potential symptoms and side effects that the patient should be aware of.

What is Tubal Ligation?

The tubal ligation procedure is used to block the fallopian tubes. This keeps any eggs from going down the fallopian tubes from the ovaries and into the uterus. Sperm will not be able to reach the ovaries as well, further decreasing the chance of pregnancy. This often irreversible solution is perfect for those women seeking a permanent birth control method.

Side effects of getting your tubes tied?

Bleeding and Infections – Some women may have excessive bleeding or infections after the surgery. This is common with many surgeries, and often requires further medical attention, depending on severity.

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Screen for & Prevent Cervical Cancer

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Prevent Cervical Cancer


According to the American Cancer Society, over 4000 women will die from cervical cancer this year. While cervical cancer was once the leading cause of cancer-related deaths in women, numbers are quickly decreasing as prevention techniques are improving. Regular tests can help women catch cervical cancer warning signs early on and adjust their lifestyles accordingly. Early testing can also help lead to early cancer treatments, improving the odds of survival. Use these techniques to help prevent the spread of cervical cancer.

Reducing Your Cancer Risks

Reducing your risk of cancer can be as simple as changing your eating habits. While some other lifestyle choices can increase your risk, such as smoking, a healthy diet can be one of the most proactive actions you can take. Avoid foods that are known to cause cancer and follow a healthy diet plan. Regular exercise can also help to reduce your risk of cancer.

HPV infections can also lead to more serious forms of cancer. Using condoms during sex and limiting the number of sexual partners a person has can reduce their risk of exposure. While HPV infections can occur in both covered and uncovered regions, using a condom can still reduce your risk overall. Read more »

Pregnant at 40 | Tips for delivering a healthy baby

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Pregnant at 40? Tips for delivering a healthy baby.

Pregnant at 40

Pregnancy is a memorable time in the life of a woman, and can sometimes be a stressful time as well. Questions about infertility often arise for women who are trying to get pregnant after 40. There are quite a few factors that contribute to fertility difficulties after 40, including illness, lifestyle factors such as smoking and obesity, stress, and diet.

At Advanced OB GYN Associates near Plano, TX, we help women who are enduring fertility challenges. Consulting professionals, like the experts at Advanced OB GYN Associates, can help relieve the strain from women and couples during this stressful time. In the meantime, we have compiled a few tips to get you started and help you maximize the chance of having a healthy baby.

Here a few tips to getting pregnant at 40+:

Change your lifestyle

Getting your body ready for a baby is like preparing a nursery: the environment you provide must be as clean and healthy as possible. For those who smoke, this is the time to stop. Staying fit by maintaining a healthy weight and reducing your level of alcohol consumption are also of paramount importance.

Visit a great doctor like the fertility experts at Advanced OBGYN

If you are 40 or older, and you are having unprotected sex with your partner two to three times a week for about three months, and there are no signs of pregnancy, see a doctor or infertility clinic. Blood tests may help discover if there are any medical reasons preventing you from conceiving.

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Should My Daughter Get the HPV Vaccine?

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Should My Daughter Get the HPV Vaccine?

The answer is yes, she should get vaccinated, and so should your son. The HPV vaccine, which prevents infection from the cancer-causing Human Papilloma Virus, is essential. Some parents may not see the need for the vaccine. They’re worried it’s not safe, or they think their kids don’t need it because they’re not sexually active, but HPV now affects over 79 million people and it is very possible to contract the disease without engaging in what many parents consider to be sexual activity.

Increased Promiscuity after HPV Vaccine Concern

While many parents have expressed concerns that a vaccine will promote sexual promiscuity, the truth is, HPV can infect the mouth and be passed orally. Because there is a greater concern that HPV can be passed through kissing, parents want to be sure they understand the increased risk.

The Risk of HPV from Kissing

HPV used to be something that people ignored, but the virus now affects millions. While children aren’t sexually active, they can still get the virus from kissing. Some moms are even blogging about the need for the vaccine given and the growing concern over mouth cancer.
Teens and preteens can contract HPV from kissing. If for example they kiss someone with HPV, this can then be unknowingly passed onto them. When Michael Douglas contracted mouth cancer from HPV, WebMD used this as a reminder that we must take preventative measures.
Most young men and women show no symptoms of having HPV. It can also clear up after 2 years without medication. Unfortunately, carriers of the virus have a much higher chance of getting:

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