A RARE CASE OF DISCORDANT ANOMALY IN A DICHORIONIC DIAMNIOTIC TWIN PREGNANCY: TESSIER CLEFT WITH SEVERE HYDROCEPHALUS IN A LOW RESOURCE SETTING.

Introduction: Congenital anomalies in twin pregnancies pose significant challenges for prenatal diagnosis and management, especially in low-resource settings. Discordant anomalies, especially those involving the central nervous system (CNS) and craniofacial structures, are rare but associated with high perinatal morbidity and mortality rates. Case Presentation: We report a rare case of Severe Tessier cleft in a discordant twin of a 27-year-old Gravida 5 Para 0+4 woman who booked for antenatal care at 31 weeks and 5 days' gestation with no prior fetal anomaly scans. She had a dichorionic diamniotic twin pregnancy, with ultrasound revealing one of the fetuses affected by severe hydrocephalus. She presented at 37 weeks and 6 days of gestation and had an elective cesarean section. The first twin, a healthy female, had a birth weight of 3.2 kg and good APGAR scores. The second twin, a male with multiple craniofacial and skeletal congenital anomalies. The APGAR scores were 6 at the first minute and 7 at the fifth minute, but died at about the third hour of life. Conclusion: This case underscores the importance of prenatal anomaly assessment and care. Multidisciplinary care, including in-depth counseling and timely intervention, is crucial to optimizing maternal and neonatal outcomes.