Given the indisputable consolidation of the dairy industry and growth of large scale dairy operations, the role of the herd veterinarian is constantly changing. A major obstacle for dairy producers, herdsmen, and veterinarians is maintaining dairy cow health in the periparturient period. Development of fresh cow monitoring programs and employee training has become the responsibility of the herd veterinarian, as, currently, on-farm employees are readily called upon for early identification and treatment of fresh cows. Predisposing risk factors for uterine infections and practical case definition criteria will be examined. Available and commonly used diagnostic modalities for postpartum uterine infections will be discussed. The controversial current and historical treatment modalities including intrauterine infusions, hormone therapy, and local and systemic antibiotic therapy will be assessed. Monitoring programs and development of a farm specific, fresh cow protocol will be described for an 800-cow, freestall-housed, Holstein dairy herd located on the Western Cape of South Africa.