The management strategies can generally be divided in two categories: preventive intervention and “wait and watch” strategy. The first group again can be divided in two categories: the prevention of MSAF to occur and the prevention of any fetal or neonatal complication once MSAF is diagnosed. The possible benefit of the “wait and watch” strategy, in which neonatal complications when they occur after a MSAF delivery are vigorously monitored and treated, is largely dependent on the level of peripartum facilities. Interestingly, these facilities in turn have largely influenced the evidence of benefit of intervention within the first attitude, as very recently shown in the 2014 Cochrane review of the effect of amnio-infusion. The corresponding author, Prof. G. Hofmeyr, kindly gave permission to describe these finding in details in this section of the BP issue. It is beyond the scope of this review to discuss interventions that are commonly used in obstetrics when – in the case of MSAF – during labor objective parameters are found of fetal distress. Moreover, evaluation of treatment strategies in case of a meconium aspiration syndrome (MAS) is also beyond the scope of this review. As in the introduction, we will evaluate the current concepts of treatment strategies also in the light of the recent paper of Hiersch et al., discriminating between primary MSAF and secondary MSAF.