At our hospital we care for high-risk pregnancies which include patients with known severe fetal anomalies. Vaginal delivery is contraindicated sometimes in patients whose pregnancies have  specific known severe fetal anomalies. These patients fall into the measure due to having a cesarean birth (when nulliparous) due to the limited denominator exclusions.  Is there consideration for further review of the limited denominator exclusion for this population and adding them to the denominator exclusion list?