A powerful earthquake has shaken Italy's industrial and densely populated northeast, killing at least six people, felling homes and factories and toppling church steeples.
Emergency services said dozens had been injured in the magnitude 6.0 quake, which struck in the middle of the night, sending thousands of people running into the streets in towns and cities across the Emilia Romagna region.
Emergency workers were sifting through the rubble of collapsed buildings for victims, hours after the quake and several aftershocks struck at 0200 GMT on Sunday local time.
Four of the dead were night-shift workers in factories which collapsed, including two who were crushed when the roof of a ceramics factory caved in the town of Sant'Agostino.
A 37-year-old German woman and another woman aged over 100 were reported to have died from shock.
The quake caused "significant damage" to historic buildings as it rattled the cities of Bologna, Ferrara, Verona and Mantua, Italy's culture ministry said.
"According to first reports, damage to the cultural heritage is significant," the ministry said, adding that it was carrying out "more detailed verifications with firemen and the civil protection service".
Italian television showed many historic buildings, including churches, reduced to heaps of rubble. Cars had been crushed under falling masonry, and the Civil Protection Agency had evacuated hundreds of elderly and vulnerable people to makeshift communal shelters in Finale Emilia and towns near the epicentre.
"We were very afraid; all the village went out into the street after the first shock," Umberto Mazza, the mayor of Ostiglia, near Mantua, told the ANSA news agency. "After the second, many took shelter in their cars, but fortunately the damage was fairly limited, above all affecting churches."
Authorities said the quake's epicentre was the commune of Finale Emilia, 36km north of Bologna, at a depth of only 5.1km.
One of the men killed in the ceramics factory collapse, Nicola Cavicchi, 35, "wanted to go to the seaside but because of the bad weather forecast he decided to go to work to replace a colleague who was sick," a family member told local media.
A 29-year-old Moroccan man was killed by a falling girder when a factory building collapsed in the small town of Ponte Rodoni di Bondeno.
The body of a fourth night-shift worker was found in the early afternoon under fallen masonry at a factory in a nearby village.
The quake was felt more than 100km away in Venice, where a Colombian family on holiday in the city said they had woken in panic when the quake shook their apartment.
In Finale Emilia, firefighters rescued a five-year-old girl who was trapped in the rubble of her house after a rapid series of phone calls between a local woman, a family friend who was in New York and emergency services.
Fallen masonry littered the streets of many towns and cities, and many historic buildings had cracks and fissures.
The region shaken by the quake is Italy's industrial heartland but also home to priceless architectural and art treasures. The historic centre of Ferrara is classified as a UNESCO World Heritage site.
Hospitals were evacuated as a precautionary measure.
Telephone switchboards of emergency services were inundated with calls immediately after the quake.
Earlier a 4.1 magnitude quake shook the Lombardy region around Milan, Italy's financial and business capital, and was felt in the historic cities of Modena, Mantua and Rovigo as well as Ferrara.
Seismic experts said the relatively small size of the aftershocks meant the worst was likely over.
In a show of calm nerves, officials opened polls as planned for the second round of local elections in the cities of Piacenza, Parma, Budrio and Comacchio.
Enzo Boschi, a reputed seismologist in Italy, said: "It is not true that there are never earthquakes in the Po plain. Ferrara suffered a very big one in the 15th century. You can still see the traces."
"Italy is a very quake-prone country. What we can say is that 5.9 or 6.0 is the maximum strength there has ever been in these zones in the past."
In March 2009, a 6.3 magnitude quake devastated the central city of l'Aquila, killing some 300 people and leaving tens of thousands homeless.