The present study aimed to monitor Holstein cows in the postpartum period, and to evaluate the occurrence of clinical diseases and their relationship with metabolic profile, milk yield and composition, and reproductive performance. One hundred and five Holstein cows, 32 primiparous and 73 multiparous, from two dairy herds in Arapoti, Paraná State, were clinically monitored up to ten days after calving. The clinical occurrences diagnosed were: dystocia, metritis, retained placenta, clinical hypocalcemia, displaced abomasum, mastitis, pneumonia, and digital dermatitis. Blood samples were collected at one, two, five, and ten days postpartum for analysis of non-esterified fatty acids (NEFA), β-hydroxybutyrate (BHB), and total calcium. Individual milk yield was measured up to 100 days in milk (DIM), and the first test-day was evaluated for milk composition. Statistical analyses were conducted using the MIXED procedure of SAS, and the fixed effects of farm (A and B), parity (primiparous and multiparous), and occurrence of clinical diseases (sick and healthy cows) were included. Forty-eight cows (45.7%) had one or more clinical occurrences. In these sick cows, the BHB concentration at five DIM was higher (P = 0.06) than in healthy cows; 0.78 and 0.57 mmol L-1, respectively. Regarding milk yield, cows with one or more clinical occurrences had lower (P < 0.01) daily milk yield up to 30 DIM, and had a tendency of lower (P = 0.09) accumulated production up to 100 DIM than healthy cows. Sick cows had a tendency to show lower (P = 0.08) milk total solids content than healthy cows; 12.04 and 12.60%, respectively. There were no significant differences between sick and healthy animals in the remaining milk components, or the reproductive parameters assessed. The differences observed for days in the first artificial insemination (AI), AI number, and days open occurred due to the effect of the herd.