This is a case report on severe meconium aspiration syndrome (MAS) that resulted in early neonataldeath. Antenatal care was provided at a low-cost non-governmental organization (NGO) clinic. Firststage of labour lasted for only 2 hours and 45 minutes. There were no foetal heart rate abnormalitiesthat were noted during the first stage of labour. Artificial rupture of membranes was done in secondstage of labour. There was no liquor amnii seen but scanty thick old meconium was noted. Deliverywas easy. The baby’s skin, nails, umbilical cord, placenta and vernix were deeply stained yellowwith old meconium. Resuscitation included suction through direct laryngoscopy, nasotrachealintubation with pulmonary toilet, as well as administration of 100% oxygen. The condition of thebaby did not improve. A diagnosis of severe MAS with hypoxic ischaemic encephalopathy (HIE),persistent pulmonary hypertension (PPH), persistent foetal circulation syndrome (PFCS) andmeconium chemical pneumonitis was made. The baby was admitted to the intensive care unit (ICU)for assisted ventilation and critical care. The condition of the baby continued to deteriorate anddemise occurred 18 hours after birth. The pathophysiologic processes of intrauterine meconiumrelease, mechanisms of foetal effects and dilemmas in management are discussed
