Anencephalic Twins in Twin Pregnancy: A rare condition

Abstract

Background: Anencephaly is a type of lethal fetal congenital abnormality. The condition is characterized by absence of cerebral hemisphere and cranial vault above the base of the skull and orbits. There is no treatment. With good modern ultrasound machines, it can be diagnosed in the late first trimester and all cases can be diagnosed in the second trimester.
Case: We report this case as it is one of those rare cases, where both fetuses are affected with anencephaly in twin pregnancy. A 35-year-old, gravida 3, para 2-0-0-2, presented at 5 months of pregnancy who came to clinic in 2022. She was found to have monochorionic and monoamniotic twin pregnancy with both twins having anencephaly. After proper counseling, the couple opted for termination of the pregnancy. She had termination of pregnancy with misoprostol with no complications.
Conclusion: We need to be vigilant for the most severe form of complications in monochorionic monoamniotic twin pregnancy. Pre-pregnancy folic acid supplementation should be given to all women few months before pregnancy and to be continued till end of first trimester to prevent neural tube diseases.