To compare the complications, delivery mode and fetal outcome between elderly primigravidae and young primigravidae. A comparative study. Department of Obstetrics and Gynaecology, POFs Hospital, Wah Cantt, from January 2001 to December 2002. One hundred and fifty six elderly primigravidae were compared with a matched pair group of younger primigravidae regarding antenatal, intrapartum and postpartum complications. Perinatal mortality was also compared. Specially designed proforma was used to record the information. Data analysis was performed using SPSS package for windows version 10.0. Results were compared using Chi-square test by keeping the p-value of <0.05 as significant. Amongst the complications during pregnancy, pregnancy induced hypertension was commonest complication in elderly primigravidas (24.35% vs. 6.41%, p-value < 0.05). Diabetes, malpresentation and premature labour were also more frequent in elderly group (p-value < 0.05). More (30.76%) of elderly group were delivered by caesarean section as compared to 16.02% in young group (p-value < 0.05). Congenital malformations of the fetus were common in elderly group (5.12% vs. 1.28%). Cases of essential hypertension (12.82% vs. 1.92%), fibroid uterus (9.61% vs 2.56%) and ovarian cyst (7.69% vs. 1.92%) were frequent in elderly group patients. Perinatal mortality was relatively high in elderly groups and compared to young patients and 17 babies in elderly group were still born as compared to 10 babies in young group. Advanced maternal age has been associated with an increased risk of various complications like hypertension, diabetes, and intrauterine growth retardation and congenital malformations. Timely and accurately diagnosis of complications and their treatment leads to favorable outcome. The higher rate of caesarean section in older primigravidas is due mainly to higher rate of obstetrical complications.