Dicephalus parapagus twinning (DPT) is the rarest conjoined twinning entity of all conjoined twins. The presence of DPT is always associated with mortality before or after delivery. Antenatal diagnosis is crucial for planning labor, assembling a team, and providing counseling. Case presentation: A 23-year-old patient (G2P1A0) at 21 weeks of pregnancy attended the ultrasound clinic for routine care. A monoamniotic-monochorionic pregnancy was observed; the twin fetuses had two heads but one body, which corresponded to dicephalus parapagus twinning. A detailed ultrasound and fetal echocardiography reveal one heart without congenital anomalies. The liver, kidneys, and bladder appeared to be normally developed. Fetal MRI and karyotyping were not carried out after counseling the parents regarding the poor outcome. A multidisciplinary team followed the case; the patient chose to continue the pregnancy. A planned elective cesarean delivery was done after 36 weeks in a tertiary medical facility. A 3,200 g newborn baby boy was delivered alive; however, he quickly developed respiratory insufficiency and failure of heart function. He deceased within 4 hours from birth; an autopsy was declined
