Back ground: Pregnancy at advanced maternal age is associated with adverse fetal outcomes & complicated by instrumental delivery or Caesarean section, prematurity, stillbirth and low birth weight compared to mothers aged 20 to 34 years. Aim: Assessment of maternal and fetal outcomes among elderly and younger primiparous women. Design: A case control retrospective design. Sample: Convenient sample of 829 women were recruited for this study divided into three groups on 3 different age levels. Group (I): “study group" all women delivering before the age of 20 years was 211. Group (II): “control group" all women delivering at age of 20 to 34 years was 539. Group (III): “study group" all women delivering at the age of 35 years and above was 79 from 1st. July 2017 to 31thDecember 2017 in women health hospital at Assiut University. Tool: Tool I: Sociodemographic and reproductive history structure interview sheet, including Personal data &Obstetrical data. Tool II: maternal and fetal outcome. Results: The complications during labour were (18.95%) had PROM in group “1". Compared to (14.95%) in group “2". And (10.12%) had preterm labour and PROM in group “3" with significance difference (P<0.05). Complication of post labour in study groups, there were (0.47%) in group “1" had post-partum hemorrhage and perineal tear in group “1" vs. no complication in both group control study with significance difference (P<0.05). Conclusion: maternal age, baseline, primiparity, educational level and residence with adverse pregnancy outcomes represented the need to control these modifiable risk factors from a public health perspective. Recommendation: awareness teaching programs about pregnancy outcomes on elderly primigravida. And orientation program through mass media regarding the benfits of early marriage.