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Objective: To determine the frequency and risk factors of meconium aspiration syndrome in babies delivered to mothers with meconium-stained amniotic fluid attending neonatal unit of tertiary care hospital. Study Design: Cross-sectional analytical study. Place and Duration of Study: Neonatal Unit, Pak Emirates Military Hospital, Rawalpindi, from Jan to Sep 2018. Methodology: All pregnant women with cephalic presentations with either spontaneous vaginal delivery (SVD) or lower segment caesarian section (LSCS) mode of delivery and having light-yellow to thick dark-green color liquor after spontaneous or artificial rupture of membrane were enrolled. Meconium aspiration syndrome along with risk factors like gestational age, weight, gender, mode of delivery, grades of meconium, and mortality were noted. Results: Of 384 patients, 190 (49.5%) were males and 194 (50.5%) females. The meconium aspiration syndrome was observed in 37 (9.6%) patients. Meconium aspiration syndrome was 2.97 times higher among patients with >36 weeks of gestation (AOR: 2.97, 95% CI: 1.12-7.89), 61% higher among patients with ≤3 kg weight (AOR: 0.39, 95% CI: 0.19-0.85), 89% higher among females (AOR: 1.89, 95% CI: 0.91-3.95), 83% higher among patients with SVD (AOR: 1.83, 95% CI: 0.89-3.75), 4.12 times higher among patients with grade III (AOR: 4.12, 95% CI: 0.51-33.45) and 8.65 times higher among patients with grade II color liquor (AOR: 8.65, 95% CI: 1.11-67.45). Conclusion: A high frequency of meconium aspiration syndrome was found in our cohort. In particular, newborn having higher gestational age, increased weight, female gender, SVD as the factors. [ABSTRACT FROM AUTHOR]