At our hospital we care for high-risk pregnancies which include patients with known prior uterine surgeries such as a myomectomy. Vaginal delivery is contraindicated sometimes in patients who have had specific known previous uterine surgery. These patients fall into the measure due to having a cesarean birth (when nulliparous) due to the limited denominator exclusions. According to ACOG and SMFM guidelines, the recommendation for delivery is cesarean birth. Is there consideration for further review of the limited denominator exclusion for this population and adding them to the denominator exclusion list?