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Two hundred thirty-five patients with transverse fetal lies incidentally discovered by sonography at more than 20 weeks of gestation were followed to term. The overall persistence of this malposition was 6.0%, ranging from 2.6% in the 20-25 week group to 11.8% in the 36-40 week group. Low implantation or placenta previa was seen in 29.3% overall and 35.7% of cases that persisted to term. Other potentially predisposing anatomic factors were encountered infrequently. Most incidentally discovered transverse fetal lies seem to be fortuitous and transient, but the likelihood of persistence increases as term approaches.

The kidneys of 20 asymptomatic pregnant women were examined sequentially from the first trimester through the postpartum period. In 41.5 per cent, progressive dilatation, more marked on the right side, was seen; however, the remainder demonstrated varying, static, or even diminishing ectasia. In all but two dilatation had reverted to normal by six weeks post partum. The finding of minimal dilatation speaks against pathologic obstruction even in the symptomatic patient. Asymptomatic patients can, however, show variable degrees of hydronephrosis with progression or regression through the course of gestation. The finding of dilatation must be interpreted with caution by virtue of these sequential variations.

Prominence of the medullary pyramids at sonography has been considered a sign of renal transplant rejection. A search of the literature reveals no previously published objective assessment of this phenomenon. Medullary pyramids of 67 normal kidneys, 53 nonrejecting transplanted kidneys, and 71 transplanted kidneys in rejection were measured. The area of the pyramid was related to the thickness of the overlying renal cortex by a "medullary pyramid index" (MPI): MPI (formula; see text) The median MPI was 4.17 for normal kidneys, 6.0 for nonrejecting transplanted kidneys, and 7.50 for transplanted kidneys in rejection. The results are significantly different (P = 0.0001) for all possible pairs. Overlap between rejection and nonrejection distributions is, however, considerable, rendering the discriminatory value of an individual observation quite low (0.69). Prominence of the medullary pyramids is therefore of very limited predictive value in the determination of transplant rejection in an individual patient.