Abstract: Objective To analyze the adverse pregnancy outcome and related risk factors of the elderly primipara.Methods In January, 2014-October, 2016, 897 cases of primipara were selected in our hospital as the research subjects. The data of them were retrospectively analyzed. According to the age of childbirth were divided into two groups:the elderly group (over 35 years, 158 cases) and normal age group (20-34 years old, 739 cases). The adverse pregnancy outcomes were compared between the two groups.According to the pregnancy outcomes, the old age group was further divided into adverse pregnancy outcome group (39 cases) and normal delivery group (119 cases). The risk factors of adverse pregnancy outcomes were analyzed.Results The incidence of postpartum hemorrhage, premature delivery, neonatal malformation, neonatal asphyxia, low birth weight, fetal birth, congenital diseases and adverse pregnancy outcomes in elderly group were significantly higher than those in the normal age group (P< 0.05). In the adverse pregnancy outcome group, the proportions of maternal history of abortion, gestational hypertension, gestational diabetes, placenta previa, cesarean section, placental adhesion/implantation, electrocardiogram abnormality and coagulation dysfunction were significantly higher than those of normal delivery group (P< 0.05). Multivariate regression analysis showed that the history of abortion, gestational hypertension, gestational diabetes, placenta previa, cesarean section, placental adhesion/implantation, electrocardiogram abnormality and coagulation dysfunction were the independent risk factors for adverse pregnancy outcomes (P<0.05).Conclusion The incidence of adverse pregnancy outcomes of elderly primipara are significantly higher than those of normal group. Abortion, gestational hypertension, gestational diabetes, placenta previa, cesarean section, placenta accreta/implant, abnormal electrocardiogram, blood coagulation dysfunction are an independent risk factor for adverse pregnancy outcomes.