Conjoint twins are one of the rare anomaly with high morbidity and mortality. These are monochorionic and monoamniotic type of gestation. Based on the site of fusion these can be of various types with thoracopagus being the most common .We are reporting a case of 19 weeks pregnant G2P1L1 patient who was reffered to our department for anomaly scan with outside ultrasound showing gross anomaly in fetus and in our department was diagnosed with cephalopagus conjoint twins . As conjoint twins carry high associated risks early diagnosis and management becomes necessary.