This book constitutes the refereed joint proceedings of the First International Workshop on Smart Ultrasound Imaging, SUSI 2019, and the 4th International Workshop on Preterm, Perinatal and Paediatric Image Analysis, PIPPI 2019, held in conjunction with the 22nd International Conference on Medical Imaging and Computer-Assisted Intervention, MICCAI 2019, in Shenzhen, China, in October 2019.The 10 full papers presented at SUSI 2019 and the 10 full papers presented at PIPPI 2019 were carefully reviewed and selected. The SUSI papers cover a wide range of medical applications of B-Mode ultrasound, including cardiac (echocardiography), abdominal (liver), fetal, musculoskeletal, and lung. The PIPPI papers cover the detailed scientific study of volumetric growth, myelination and cortical microstructure, placental structure and function.