Acrania is a rare lethal congenital anomaly in which there is partial or complete absence of the fetal scalp bones (calvarium). The brain tissue is completely but abnormally developed. We present a 22-year-old primigravida, an unmarried secondary school drop-out who presented for prenatal care at 31 weeks of gestation and developed pre-term prelabor rupture of membranes a week later. An obstetric scan at presentation revealed acrania of the fetus and she was offered medical termination of the pregnancy which was declined insisting on awaiting fetal maturity. She was managed conservatively until 34weeks of gestation when she had a lower segment caesarean section. The Outcome was a live 1.8kg female fetus with acrania and other malformations who suffered an Early Neonatal Death. Her late antenatal booking deprived her of an early diagnosis when counselling for medical termination would have been more acceptable while her religious background gave her optimism for a favourable outcome despite adequate counselling on the prognosis for this very rare lethal medical condition diagnosed in utero.