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PHOTOS: Italy pay the price for being too defensive
Diego Godin's late header helped Uruguay book a second round berth and send Italy out of the World Cup.
The Group D match in Natal was Uruguay's 50th match in the World Cup and the two-time champions ensured it was a memorable one.
Captain Godin, whose goal at the Camp Nou also ensured Atletico Madrid its first Primera Liga title in 18 years last month, scored yet another crucial goal when his team needed it the most.
The Italian players were still complaining to the referee after Uruguay striker Luis Suarez appeared to bite Giorgio Chiellini shortly before Godin rose to head in the winner.
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Marchisio was shown a straight red
The only goal of what was otherwise an uninspiring game came after Italy had been reduced to 10 men.
Referee Marco Rodriguez showed a red card to Claudio Marchisio, for a foul on Egidio Arevalo Rios, thereby dealing a crucial blow to the Azzurri's prospects.
Before that, it looked like Italy would succeed in suffocating Suarez and the Uruguayan attack and secure the point they needed to progress along with group winners Costa Rica.
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Immobile missed a good chance
Ciro Immobile missed what was Italy's best chance in the first half.
The Dortmund-bound striker's shot was way off the target when he was clearly in front of the goal.
Immobile made way for Antonio Cassano in the second half but it made no difference to Italy's fortunes.
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Pirlo's 13th minute free kick tested Muslera
There were few clear chances in a bad-tempered game littered with fouls with a draw enough to send the Italians through to the last 16 as group runners-up.
Andrea Pirlo's 13th minute free kick tested Uruguay goalkeeper Fernando Muslera but he pushed it over the crossbar.
But chances for Italy were few and far between. In the final analysis, it was their defensive approach that cost Italy a place in the second round.