Background: Amniotic fluid surrounds the baby in utero and provides a protective and low resistance environment and acts as a cushion for the baby. It is secreted by amniotic membranes, foetal skin and fetal urine. The objectives of this study was to identify the incidence of meconium stained amniotic fluid, perinatal outcome and the risks during pregnancy leading to in utero passage of meconium.Methods: A prospective study conducted in Sri Guru Ram Das University, Amritsar, between 1st December 2014 to 1st June 2016. All live births with meconim stained amniotic fluid without congenital malformation, twin or multiple organ dysfunction were taken as subjects of this study. Maternal obstetric history and risk factors were asked and foetal parameters including gestational age, fetal presentation, mode of delivery, birth weight, sex, Apgar score, age at onset of respiratory distress, treatment and outcome were observed.Results: Out of 1121 admissions in NICU, 12% of inborn and 9.6% of outborn were with MSAF, out of which 34% developed MAS. Majority of neonates were observed to be males (73.6%), term neonates (67.2%), weight 2.5-3.5 kg (76.9%) with mean weight being 2.701 kg±0.558 kg and 16% mortality including 9 inborn and 11 outborn neonates. Mean age at onset of respiratory distress was 18.43 minutes±11.52 minutes. Neonatal outcome was significantly related to weight, APGAR score at 5 mins, and development of complications like MAS, hypoxic ischemic encephalopathy, necrotizing enterocolitis, acute renal failure and severe thrombocytopenia. Culture proven septicaemia was seen in 21.6% cases. Mean duration of stay in NICU was 6.48 days±0.54 days.Conclusions: MSAF has significant effect on perinatal outcome and close observation is required to prevent and treat complications thus reducing mortality.