Objective To evaluate outcomes in women >= 45 years of age in comparison to a group of women aged 40 to 44 years.Materials and Methods A cohort study was conducted including women >= 45 years who delivered at > 24 weeks gestation during the period (1989-2011). Women aged 40 to 44 years formed the comparison group. The maternal demographics, mode of conception, maternal complications, timing and mode of delivery, neonatal features and postpartum complications were included as outcomes. Statistical analyses were performed using the t-test and Chi-square test.Results There were 67,278 deliveries; 140 occurred in women >= 45 years of age, (2.1/1,000). Compared with the 40 to 44 year age group (n = 139), women >= 45 years had higher body mass index (26.7 +/- 4.7 vs. 24.6 +/- 7.1, p = 0.01), and were more likely to have a previous pregnancy loss at = 45 years were more likely to be delivered by cesarean section (45 vs. 30.2%, p = 0.01).Conclusion Women aged >= 45 years have comparable outcomes to those aged 40 to 44 years, albeit the presence of pre-existing maternal disease is higher and associated with a poor outcome.