- Abstract Objective: To detect factors that are associated with MSAF among deliveries of SGA neonates and to identify perinatal outcomes of deliveries of SGA infants complicated with MSAF. Methods: A population-based study comparing deliveries of SGA neonates with and without MSAF was conducted. Deliveries occurred during the years1988- 2007 at the Soroka University Medical Center. Risk factors for MSAF among SGA infants were evaluated. Incidence of adverse pregnancy outcomes were compared between deliveries of SGA neonates with and without MSAF. Results: During the study period 9,583 deliveries were of SGA neonates. Of these, 16.6% (n=1,597) were complicated with MSAF. Among SGA neonates, older maternal age, multiparty, lack of prenatal care and weight were significantly associated with MSAF. Having delivered an SGA infant with MSAF was associated with decreased rates of induction of labor and increased rates of labor dystocia, delivery by cesarean section and fetal distress. Using multivariable regression models, having delivered an SGA infant with MSAF was independently associated with fetal distress. Conclusion: Among SGA neonates, deliveries complicated with MSAF are associated with additional adverse pregnancy outcomes.