Diego Maradona's Argentina booked their place at next summer's World Cup finals as substitute Mario Bolatti hit a later winner.
Huracan midfielder Bolatti, winning just his third cap, fired home with six minutes remaining after the home defence failed to deal with Juan Sebastian Veron's drilled effort from a free-kick.
The hosts ended the night with 10 men after Martin Caceres picked up a second yellow card in the build up to Argentina's winner.
Maradona has come in for fierce criticism for his disjointed handling of Argentina's qualification campaign, which as seen him field over 70 players, but victory in Montevideo tonight should silence his critics - until next summer at least.
Uruguay, meanwhile, now need to prevail in a play-off against Honduras or Costa Rica if they are to join Argentina in the finals.
Uruguay were quickly out of the blocks and looked to harry the opposition in the early exchanges.
Argentina appeared nervy and their backline was soon exposed when Jorge Rodriguez broke through in the fourth minute but was beaten to the ball by the advancing Sergio Romero.
The visiting keeper crashed his attempted clearance against the legs of Rodriguez, however, and was fortunate that the ball span harmlessly out of play rather than into the unguarded net.
Gabriel Heinze underlined the tension in the Argentinean ranks when he picked up a yellow card for a rash challenge on Maxi Pereira after nine minutes.
The hosts threatened from the resulting free-kick but Andres Scotti saw his header sail wide of the target.
Uruguay continued to make all the running as the half wore on and after 23 minutes Alvaro Pereira fizzed a well-struck shot wide of the target from the left edge of the area that had Romero scrambling.
Argentina had a decent penalty shout turned down after 28 minutes Heinze appeared to be wrestled to the ground by Diego Perez as he attempted to reach Veron's free-kick, but referee Carlos Amarilla waved away the appeals.
The hosts fittingly closed out a half they had largely bossed with another effort on Romero's goal, this time Diego Forlan sending Argentinian hearts fluttering with a run and shot that flew just wide of the right-hand post.
Atletico Madrid striker Forlan unleashed a shot from distance after 50 minutes as the hosts continued to press after the break, but Argentina nevertheless appeared more in control at the back following the interval.
Barcelona playmaker Lionel Messi had been largely anonymous in the opening 45 but gave a display of his talents after 61 minutes when he ran at the heart of the Uruguayan defence before playing in Gonzalo Higuain but the Real Madrid man was beaten to the ball by the alert Fernando Muslera.
Argentina's defence had a let-off after 74 minutes when they left Diego Lugano unmarked in the area from Forlan's inswinging free-kick but the defender fluffed his lines as his attempted header hit his back and went out of play.
Uruguay's task was made all the harder when they were reduced to 10 men after 83 minutes when Caceres picked up his second booking of the night for using his arm to pull down Jonas Gutierrez.
And the game was finally up for Uruguay when they conceded from the resulting free-kick.
Messi started the move, shifting the ball left for Veron to take a shot from long range which ricocheted in the area before falling to Bolatti, who brought the ball under control before slotting home to book Argentina's safe passage to South Africa.
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