At our hospital,  we treat several high risk patients who have neurosurgery, spine, and IBD complications which vaginal deliveries are contraindicated.  These patients have cesarean deliveries and as a result fall into the measure due to the limited denominator exclusions. Is there consideration for reviewing more diagnosis which are contraindicated for a vaginal  deliveries according to ACOG and SMFM guidelines and  and adding them to the exclusion list?