Background: Increasing maternal age is independently associated with specific adverse pregnancy 
outcome. But, it was noted when patients of advanced maternal age were followed and delivered their 
infants in modern tertiary care center, no increase in adverse outcome was noted. Objectives: This 
prospective study in which maternal and perinatal outcome in pregnant women aged 40 years and 
above compared with those of young women aged 25-35 who delivered in El-Eman General 
Hospital. Patients and methods: 422 women were divided into 2 groups. The first group contain 211 
women whose age ranges from 25-35 years, the second group contain 211 women whose age 40 years 
and above. Results: There were significant increases in rates of Pregnancy Induced Hypertension 
among pregnant women aged over 40 years (12.3%) compared to older primigravida aged over 40 
years. There was significant increase in the rate of preeclampsia among women aged over 40 years
(18.5%). Incidence of preeclampsia increase in grand muliparus women aged ≥ 40 years (18.5%) and 
among women aged 25-23 years (7.6%). Risk of bad perinatal outcomes increases in relation to 
medical diseases with pregnancy. Conclusion: Women aged ≥ 40 years have higher risk of Cesarean 
section than young women. There were statistically significant increases in the rate of NICU referral 
due to perinatal problems among women with advanced age. The mother's high age can be an 
independent factor for adverse pregnancy outcomes, complete awareness of pregnancy outcomes in 
these age groups for midwives and gynecologist is needed to protect health of mothers.