Background: The elderly primigravida is defined as a woman who delivered fetus for the first time at the age of 35 years or older. Progressively, this has become more common in our contemporary society and traditionally such pregnancy is regarded as high risk. Objectives: The aim of this study was to compare the pregnancy outcomes in elderly primigravidae aged 35 years and above with young primigravidae aged < 35 years at time of delivery. Patients & Methods: This prospective observational study was carried out at Zagazig University, maternity Hospital between 1st January 2017 to 31st December 2017. The sample size was 250 women; they were 120 primigravida women aged 35years and above at time of delivery (Elderly porimigravidae group) and 130 young primigravidae (control group) aged < 35 years at time of delivery who delivered during the same period in the same hospital. Results: women aged 35 years and over had a higher prevalence of associated medical disorders as diabetes mellitus, hypertension. The indication for ceasarean section was preeclampsia, followed by malpresentation and fetal distress. The most frequent pregnancy complications were preeclampsia, gestational DM and preterm labor. The incidence of low birth weight was higher among neonate borne to older mother. NICU admission increase with elderly primigravida. Conclusions: Elderly Primigravida are at an increased risk of pregnancy-induced hypertension/Preeclampsia, gestational diabetes, malpresentaion, multiple pregnancy and ceasarean section than the younger primigravida, it suugested that the early booking and extra obstetric alterneess shall improve the pregnancy outcomes in this category .