Since a few decades, dairy cows have shown a steep increase in milk production, which is unfortunatelyaccompanied by a dramatic decline in reproductive performance.In these high yielding cows there are more puerperal problems than in low yielding cows, such as retained placenta,acute metritis and abnormal vaginal discharge. Cows affected by retained placenta and/or acute metritisare furthermore at a significantly higher risk of other typical ‘dairy cow diseases’ as acetonaemia, leftdisplaced abomasum and cystic ovarian disease.Therefore it is important that puerperal metritis is treated properly with broadspectrum antibiotics bothparenterally and intra-uterine during 1 – 3 days depending on the severity of the symptoms. Cows with chronicendometritis need no treatment before 30 days post partum. From day 30 on they should be treated twicewith prostaglandins at an interval of 14 days.A challenge for the future is to clearly determine all risk factors for uterine disease. One of the major riskfactors is a retained placenta. Correct nutrition during the dry off period and a normal calving process underhygienic conditions are the paramount factors in the prevention of this risk factor.