Twin Pregnancy Discordant for Anencephaly with Severe Polyhydramnios Journal of South Asian Federation of Obstetrics and Gynaecology, September-December 2015;7(3):223-224 223 JSAFOG ABSTRACT Twin pregnancy is a high-risk pregnancy with many complications. Anencephaly is one anomaly which is commoner in twins than in singleton pregnancy. Dizygotic as well as monozygotic twins discordant for structural anomaly requires an individual approach regarding pregnancy complications. The major issue with these pregnancies require early diagnosis and management options, especially if diagnosed early. Selective fetocide is a management option in at least dizygotic twins. Keywords: Anencephaly, Dizygotic, Monozygotic, Twins. How to cite this article: Najam R. Twin Pregnancy Discordant for Anencephaly with Severe Polyhydramnios. J South Asian Feder Obst Gynae 2015;7(3):223-224. Source of support: Nil Conflict of interest: None Date of received: 14 August 2015 Date of acceptance: 13 September 2015 Date of publication: December 2015 INTRODUCTION Twin pregnancy is a known high-risk pregnancy with its own inherent complications, like postpartum hemorrhage (PPH), polyhydramnios, antepartum hemorrhage (APH), etc. Prevalence of structural anomalies like anencephaly is higher than in singleton pregnancy. 1,2 In a study, the prevalence was found to be 10.4/10000 in singleton. 3 The prevalence of concordancy for anencephaly in monozygotic twins is twice as high as in dizygotic pregnancy. 4 We present an interesting case of twin pregnancy where the patient presented with severe polyhydramnios in labor in the emergency. CASE REPORT Mrs X a 26 years old female, fourth gravid with all three live issues reported to the emergency department of Teerthanker Mahaveer Medical College and Hospital, Moradabad, Uttar Pradesh, India, with complaints of amenorrhea of seven and a half months, excessive disten- sion of abdomen since the past 1 month, excessive weak- ness, breathlessness along with pain lower abdomen for the last 2 days. Patient had consulted a untrained birth attendant, who referred her to our hospital. Her general condition was satisfactory with a pulse rate of 94/minute, BP was 120/80 mm Hg, temperature was normal, severe pallor and pedal edema were present. On per abdomen examination, the abdomen was over distended with a tense shiny skin, both flanks were full. Liquor was increased clinically. Multiple fetal parts were felt. Both fetal heart sounds were localized. Uterine contractions were felt. One of the fetus was breech and the other cephalic. On per speculum examination, no leaking was present. On per vaginum examination, os was 3 cm dilated, patulous, 30 to 40% effaced and membranes were present. Routine investigations were as follows: • Hemoglobin: 4.4 gm% • TLC: 11,600 • DLC: P84L16 • Blood sugar: 84 mg% • Blood urea: 27 mg% • Urine: Protein in traces • VDRL: NR Ultrasonography revealed twin pregnancy, presen- tation of one fetus was breech and the other cephalic. Average gestational age was 30 weeks, first fetus was anencephalic and other was normal. The amniotic fluid index (AFI) was 30 cm. Ultrasonographic-guided amnio- centesis was done to prolong the pregnancy and reduce the maternal distress. The patients was admitted and kept on conservative management with intravenous antibiotics and injection betamethasone. Two units of packed red blood cells was transfused and the patient was left for spontaneous labor. The patient delivered vaginally after 3 days of admission. The first twin was born by breech and the JSAFOG CASE REPORT 10.5005/jp-journals-10006-1365 Twin Pregnancy Discordant for Anencephaly with Severe Polyhydramnios Rehana Najam Associate Professor Department of Obstetrics and Gynecology, Teerthanker Mahaveer Medical College and Research Centre, Moradabad Uttar Pradesh, India Corresponding Author: Rehana Najam, Associate Professor Department of Obstetrics and Gynecology, Teerthanker Mahaveer Medical College and Research Centre, Moradabad Uttar Pradesh, India, Phone: 919837291920, e-mail: rehananajam01@gmail.com