Inclusion Criteria:  Multigravida pregnant women with meconium stained amniotic fluid encountered either by spontaneous/artificial amniotomy during the first stage of labor in the ward provided that the gestational age at delivery is 37 weeks of gestation or more. Singleton living gestation Cephalic presentation Adequate pelvis An informed written consent for the proposed study.  Exclusion Criteria:  Primigravids Women with previous cesarean section Multifetal gestation Intrauterine fetal death Malpresentations Prematurity (<37 weeks ) Abnormally invasive placenta during the current pregnancy Medical disorders with pregnancy Contracted pelvis Evidence of maternal infection Allergy to azithromycin or other macrolides that is self-reported or documented in the medical record.