Background Clinicians often refer to published or local guidelines when counselling expectant parents on perinatal care decisions at the limits of viability. The number and quality of guidelines used worldwide is unknown.

Objectives Assess quality of international guidelines regarding perinatal care of 22–25 wk GA infants.

Methods MEDLINE, Pre-MEDLINE and TRIP databases were searched for international guidelines using specific criteria. Titles/abstracts were screened and the final selected guidelines were reviewed and appraised by two reviewers using the validated AGREE-II (Appraisal of Guidelines for Research and Evaluation Instrument) tool. This instrument assesses guideline quality (scope, stakeholder involvement, rigour/transparency, clarity, applicability, editorial independence). Items with score differences >3 were reviewed for discussion.

Results Database and grey search yielded 263 publications. Screening left 37 guidelines, 16 of which met all inclusion criteria. Regions represented included North America, Australia and Europe. Appraisal using the AGREE-II tool by three independent appraisers revealed deficits within all domains, predominantly ‘rigour of development’ and ‘applicability’. Overall quality scores ranged from 11%-61%; no guideline was deemed suitable for use. Only Swiss and Canadian guidelines were considered useable with significant modifications.

Conclusion Several international guidelines on perinatal care of 22–25 wk GA infants exist. Using the AGREE-II tool, we identified many deficits in the quality of these guidelines. Not a single guideline was deemed suitable for use using the AGREE-II tool. Use of poorly developed guidelines may be detrimental to decision-making, thus there is a need for transparent and rigorous guidelines regarding the perinatal care of 22–25 wk GA infants.