$re = '~<h4>(?:(?!<\/?h4>).)*?<\/h4>(?!.*?<div class=\'content\'>)~s';
$str = '<div class=\'content\'>
<img style=\'border-style: solid; border-width: 1px;\' src=\'/media/uploads/defaults/181\'/><br/><br/>
<div class=\'imgCaption\'>
Reverse Osmosis Caption
</div>
</div>
<pagebreak/>
<h3>Access </h3>
<h4>Type</h4>
<div class=\'content\'>
Your plumbing system is accessible with a Main Shut off Valves
</div>
<h4>Location</h4>
<pagebreak/>
<h3>Operation & maintenance #1</h3>
<div class=\'content\'>
All wastewater treatment systems and their components require regular maintenance.
</div>
<h4>Activity</h4>';
preg_match_all($re, $str, $matches, PREG_SET_ORDER, 0);
// Print the entire match result
var_dump($matches);
Please keep in mind that these code samples are automatically generated and are not guaranteed to work. If you find any syntax errors, feel free to submit a bug report. For a full regex reference for PHP, please visit: http://php.net/manual/en/ref.pcre.php