Backed into a corner, world number five Paolini mounted a comeback of her own in the second set, winning six successive games after herself trailing 4-0.
With this win, he has improved his record in Rome to nine wins and four losses.
World number one Jannik Sinner produced a sublime semi-final display as he fought back from a set down to beat American Tommy Paul 1-6, 6-0, 6-3 on Friday to set up an Italian Open final showdown with Carlos Alcaraz.
Four-times Grand Slam champion Alcaraz, who is gearing up to defend the French Open title later this month, fired off 24 winners in a strong performance to seal victory.
World number one Novak Djokovic required medical attention after being struck on the head by a water bottle following his second-round win over France's Corentin Moutet at the Italian Open on Friday.
Chilean 21st seed Nicolas Jarry outclassed American Tommy Paul 6-3, 6-7(3), 6-3 to reach the Italian Open on Friday as former champion Alexander Zverev recovered from a slow start to beat Chilean Alejandro Tabilo 1-6, 7-6(4), 6-2.
The world number one overcame a sluggish start to defeat Argentine Diego Schwartzman 7-5, 6-3 for a record 36th ATP Masters crown.
Swiatek downs Gauff to meet Sabalenka in Italian Open final
Organisers confirmed Osaka had withdrawn due to a left ankle injury and her opponent Sara Sorribes Tormo will now face lucky loser Nuria Parrizas Diaz.
'I'm just glad to overcome today's challenge in straight sets and move on.'
'I played a good match, maybe he was a little bit tired from New York (where) he played an amazing tournament.'
Professional sports events in Italy have been played without fans since March due to the COVID-19 pandemic but sports minister Vincenzo Spadafora said fans would be allowed to attend the closing stages of the tournament on Sunday and Monday.
Defending champion Rafa Nadal began his Italian Open campaign with an emphatic 6-3 6-1 victory over big-serving American John Isner to move into the last-16 on Wednesday.
German veteran Tommy Haas provided a reminder of his claycourt skills to beat Stanislas Wawrinka on Thursday and reach the quarter-finals of the Rome Masters where Rafael Nadal and Andy Murray will resume their rivalry.
Simona Halep claimed the Italian Open in Rome on Monday
Rafael Nadal made short work of his great rival Roger Federer to win the Italian Open, his sixth trophy of the year, 6-1, 6-3 on Sunday.
A rusty Venus Williams was blown away 6-3, 6-2 by rising British left-hander Laura Robson at the Rome Masters tennis on Monday.
In the women's Italian Open at the same atmospheric Foro Italico venue home fans were given something to shout about when Sara Errani reached the semi-finals with a superb 6-3, 4-6, 6-2 victory Li Na while Rafael Nadal overcame a first-set thrashing by Andy Murray to reach the semi-finals.
The 23-times grand slam winner made her comeback at Indian Wells in March and has not played since her opening round defeat by Japan's Naomi Osaka at the Miami Open.
World No. 1 Victoria Azarenka suffered a blow to her French Open preparations when she was forced to pull out of the Italian Open with a right shoulder injury on Wednesday, but an aching Roger Federer gingerly advanced to the third round.
French Open champion and home favourite Francesca Schiavone lost in the quarter-finals of the Italian Open on Friday as Samantha Stosur gained revenge for defeat in last year's Roland Garros final.
Roger Federer's 2009 claycourt season ended in a blaze of glory, capturing an elusive French Open crown on an unforgettable Paris afternoon last June. His 2010 bow could hardly have been more dreary in comparison.
While diver Tom Daley is already something of a celebrity, neither he nor his coach expected him to be world 10-metre platform champion at the age of 15.
The Serbian second seed will now play Austrian Dominic Thiem, who shocked seven times winner Rafa Nadal on Friday but has lost his previous four encounters with Djokovic, in the evening semi-final.
The Swiss re-entered the upper echelon of women's tennis at number 14 after winning the Italian Open
They were beaten by French duo Michael Llodra and Fabrice Santoro in the semifinals of the ATP Tennis Masters in Rome.
Andy Murray punctured Novak Djokovic's air of dominance by beating the out-of-sorts Serb in straight sets in the final of the Italian Open in Rome on Sunday.
The 'Big Three' of men's tennis have found some "fresh energy" to thwart the charge of younger players on the tour, world number one Novak Djokovic said after setting up yet another title clash against his biggest rival against Rafael Nadal.
World number one Novak Djokovic turned the page on his contentious US Open exit and began his claycourt season with a convincing 6-3, 6-2 victory over wildcard Salvatore Caruso in the second round of the Italian Open.
Nadal, who is the clear tournament favourite and looks to be in the form of his life on clay this season, raced into a 3-0 lead before Spanish compatriot Almagro felt his left knee with less than half an hour played.
In the women's draw, Angelique Kerber was knocked out in a 6-3, 6-1 defeat to Czech Katerina Siniakova while Coco Gauf won her first ever match on clay.
With rain having washed out Wednesday's play, Federer along with champion Rafael Nadal and top seed Novak Djokovic all face playing back-to-back matches on Thursday if they want to reach the quarter-finals.
The sixth seed, a winner in Madrid last weekend for the second year in a row, will meet either Spain's French Open champion Garbine Muguruza or Ukraine's Elina Svitolina in Sunday's final.
Djokovic did not drop a set en route to the final in Rome
Raducanu retires in Rome as back injury persists, Jabeur survives early scare
Wawrinka, who was making his first appearance since February after recovering from a persistent knee injury, committed 30 unforced errors as he struggled to rediscover his rhythm on his return to clay.
She will now play Dutch 15th seed Kiki Bertens, who saw off Australian qualifier Daria Gavrilova 6-3, 6-3, in Saturday's semi-final on the red Foro Italico clay.
The unseeded Indo-Canadian pair defeated their fancied rivals 6-3, 3-6, 10-5 in a round of 16 tie of the ATP Masters 1000 event.
The 31-year-old becomes world number one for a sixth time ahead of the French Open.
Roger Federer's struggles continued when he was beaten 7-6 (2), 6-4 by fast-rising Austrian Dominic Thiem in the third round of the Italian Open in Rome, on Thursday.
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