Meconium is frequently found in amniotic fluid, especially in full-term and post-term pregnancies. The most significant consequence of meconium-stained amniotic fluid (MSAF) is meconium aspiration syndrome (MAS) which occurs in approximately 5% of cases of MSAF. MAS is a life-threatening state – in spite of advancements in its treatment, the mortality rate is still between 5 and 40%, and there are risks of long-term damages in the respiratory and nervous systems. The main cause of meconium aspiration is asphyxia, which due to hypoxia leads to a relaxation of the sphincter, release of meconium and aspiration caused by inspiration. Because of this, the key to the prevention of MAS is to prevent asphyxia and to have quality obstetric care. MAS is characterised by a complex pathophysiology. The aspirated meconium leads to a mechanical obstruction of the airways, a decrease in surfactant synthesis, an inflammation of the lung tissue and the absence of fetal bloodstream transformation. MAS treatment is based on oxygenating, respiratory support by mechanical ventilation, application of surfactants, nitric oxide (NO), and in recent years also extracorporeal membrane oxygenation (ECMO) in severe cases of MAS. Other drugs and methods that have not been scientifically proven as useful are being used or tested and could be applied in the future.