Introduction

The scientific study of ageing of the uterus and placenta is clinically relevant because of the associations between advanced maternal age and outcome of pregnancy. The details of these associations are addressed in other sections of this book. However, some clinical observations are also included in this chapter to demonstrate parallels between the scientific observations and the clinical outcomes that are thought to be related. The subject is addressed in terms of the ageing myometrium, decidua and placenta. The key clinical parallels are the association between advanced age and the risks of both complicated childbirth and antepartum stillbirth. The association with complicated childbirth is paralleled with the evidence that ageing adversely affects the myometrium. The association with stillbirth will be paralleled with evidence that ageing affects formation and development of the placenta, from implantation onwards. Some of the evidence relating to ageing and implantation may also be relevant to ageing and fecundity, but this is not discussed in detail.

Molecular and cellular aspects of ageing

The scientific literature on the mechanisms of ageing is vast and I make no attempt to summarise it here. However, I will briefly discuss two biological mechanisms that are thought to be important in ageing, namely telomere length and failure of autophagy.