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Objective To study maternal and intrapartum factors associated with adverse neonatal outcome in deliveries complicated by meconium‐stained amniotic fluid (MSAF). Methods A retrospective cohort study of all women with singleton gestations undergoing trial of labor with MSAF during 2011–2020. Deliveries with adverse neonatal outcome were compared with deliveries without. Results Overall, 11 329 were included; 376 (3.3%) neonates were diagnosed with adverse neonatal outcomes. Multivariable regression analysis underlined the following factors as independently associated with composite adverse neonatal outcome: pregestational diabetes (odds ratio [OR] 3.21, 95% confidence interval [CI] 1.09–9.43, P = 0.031), polyhydramnios (OR 2.14, 95% CI 1.33–3.44, P = 0.002), fever (OR 2.52, 95% CI 1.67–3.80, P < 0.001), and amnioinfusion (OR 1.73, 95% CI 1.24–2.2438, P = 0.003). When 0, 1, 2, and 3 of the independent risk factors identified were present, the rates of adverse neonatal outcome were 2.9%, 5.5%, 10.0%, and 100%, respectively. Conclusion The current study's results suggest that special attention should be payed to deliveries complicated by MSAF and with any of the following factors—polyhydramnios, intrapartum fever, amnioinfusion, and pregestational diabetes.