More women are postponing pregnancy into the fourth and fifth decades of life for a variety of reasons. Advanced maternal age, traditionally defined as age more than 35 years, has been associated with increased obstetric morbidity and interventions. In addition, perinatal complications are reported to be higher in this patient population, although recent data point to a more favorable outcome. This article reviews the available literature with special emphasis on antepartum, intrapartum, and postpartum complications and perinatal outcome.