Aims and objectives: Early diagnosis and management of a case of B12 and folic acid deficiency, as there is no gold standard protocol for diagnosis of this type of anemia. Case report: A 24 years G2P1L1A0 with 32 weeks gestation presented with: Hb: 3 g%, red blood cells (RBCs: 1700 cells/ mm3, white blood cells (WBCs): 2700 cells/mm3, platelets: 80000 cells/mm3. Ultrasound is suggestive of single live intrauterine pregnancy of 32.4 weeks, with cephalic presentation with symmetrical intrauterine growth restriction, amniotic fluid index (AFI): 7–8 cm. Obstetric Doppler suggestive of increased SD ratio in umbilical artery, reduced periodontal index (PI) in the right uterine artery. Patient treated with 3 units of packed cell colume (PCV) with 3 doses of intravenous B12 and vitamin C injections followed by oral iron, oral B12, and folic acid. Patient advised follow-up after 15 days. Reports after 15 days: Hb: 8.6 g%, RBCs: 3.07 x 1012/L, WBCs: 10.2 x 109/L, Pletlets: 33.2 x 109/L Ultrasound is suggestive of single live intrauterine pregnancy of 33.3 weeks gestation with cephalic presentation, AFI: 8–9 cm. Obstetric Doppler: No significant abnormality in obstetric Doppler indices in the present scan. Conclusion: Early intervention and diagnosis of megaloblastic anemia in late pregnancy reduce significant maternal and fetal morbidity and mortality.