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Conjoined twins are rare, occurring in 1 in 250 000 live births, with cephalopagus twins reported in 1 in 3 000 000 live births. In cases of conjoined twins, early diagnosis is crucial for the health of the mother and pregnancy management and counselling. We present a case of cephalo-omphalopagus conjoined twins, with imaging findings, delivery considerations and patient-centred care recommendations. A patient in her 30s, gravida 2 para 0, was transferred to our care after an anatomical ultrasound demonstrated fusion of the fetal heads, chests and abdomens. Due to a complex congenital heart defect with a shared heart, the family was counselled on the anticipated prognosis and management options. Twin girls were delivered at 34+4 weeks via caesarean delivery, and the family was able to spend time with them as desired. This case demonstrates that prenatal diagnosis is helpful, and family involvement through patient-centred care and shared decision-making can improve perceived outcomes.