Objective: To explore the correlation between prenatal high-risk factors in predicting amniotic fluid fecal contamination and the degree of amniotic fluid fecal contamination with neonatal outcomes and delivery methods through a historical cohort analysis. Methods: This study adopted a historical cohort study method and included 2,260 pregnant women who were diagnosed and delivered as the research subjects, among whom 418 patients had amniotic fluid fecal contamination and 1,842 patients did not. The differences in the effects of prenatal high-risk factors such as age, gestational weeks, abnormal fetal position, abnormal labor process, abnormal umbilical cord, oligohydramnios, premature rupture of membranes, gestational diabetes, anemia, and mode of delivery on meconium contamination of amniotic fluid were compared, and the prenatal risk factors of meconium contamination of amniotic fluid were studied. The differences in neonatal asphyxia, neonatal aspiration pneumonia, neonatal hypoxic-ischemic encephalopathy and delivery methods among patients with grade I, grade II and grade III fecal contamination were compared respectively, and the relationship between the degree of amniotic fluid fecal contamination and neonatal outcomes and delivery methods was studied. Results: Abnormal labor process, abnormal umbilical cord, oligohydramnios, premature rupture of membranes, anemia, mode of delivery, and gestational age at delivery were all risk factors for amniotic fluid meconium contamination (P<0.05), while gestational diabetes was a protective factor for amniotic fluid meconium contamination (P<0.05). However, the maternal age and the presence or absence of abnormal fetal position had no statistically significant influence on amniotic fluid meconium contamination (P>0.05). By analyzing the correlation between the degree of amniotic fluid fecal contamination and neonatal outcomes as well as delivery methods, it was found that the degree of amniotic fluid fecal contamination in patients was positively correlated with delivery methods (cesarean section), neonatal asphyxia, neonatal aspiration pneumonia, and neonatal hypoxic-ischemic encephalopathy (P <0.05). Conclusion: Abnormal labor process, abnormal umbilical cord, oligohydramnios, premature rupture of membranes and anemia, mode of delivery and gestational age at delivery may all increase the risk of fecal contamination of amniotic fluid in patients. However, the degree of fecal contamination of amniotic fluid after delivery is positively correlated with mode of delivery (cesarean section), neonatal asphyxia, neonatal aspiration pneumonia and neonatal hypoxic-ischemic encephalopathy. It can serve as an important predictive reference for the early clinical judgment of meconium contamination in amniotic fluid.